Active NPI
Daniel S Park, PA-C
- Military Health Care Provider
- Fort Knox, KY
National Provider Identifier
1225741952
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 4076 Neely Road
Fort Wainwright, AK 99703 - Phone
- (907) 361-4000
- NPI assigned
- Dec 27, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary | ||
| Military Health Care Provider | 171000000X |
Addresses
Primary practice location
4076 Neely Road
Fort Wainwright, AK 99703
Mailing address
4076 Neely Road
Fort Wainwright, AK 99703
Phone (907) 361-4000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1204605 | Other | NCCPA IDENTIFICATION NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1789689600000",
"number": "1225741952",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4076 NEELY ROAD",
"city": "FORT WAINWRIGHT",
"state": "AK",
"postal_code": "99703",
"telephone_number": "907-361-4000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4076 NEELY ROAD",
"city": "FORT WAINWRIGHT",
"state": "AK",
"postal_code": "99703",
"telephone_number": "907-361-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "DANIEL",
"middle_name": "S",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-12-27",
"last_updated": "2026-09-18",
"certification_date": "2026-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
},
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCCPA IDENTIFICATION NUMBER",
"identifier": "1204605",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Knox, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.