Active NPI
Stephanie K Kuzuguk, CHA IV
- Community Health Worker
- Shishmaref, AK
National Provider Identifier
1245507938
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 09-1019-IV
- Practice address
- 133 Lagoon Street
Shishmaref, AK 99772-0133 - Phone
- (907) 649-3311
- Fax
- (907) 649-2083
- NPI assigned
- Nov 23, 2011
- Last updated
- Nov 23, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 09-1019-IV | AK | Primary |
Addresses
Primary practice location
133 Lagoon Street
Shishmaref, AK 99772-0133
Mailing address
P.O. Box 133
Shishmaref, AK 99772-0133
Phone (907) 649-3311
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09-1019-IV | Other | AK | CHA IV |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09-1019-IV | AK | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322006400000",
"number": "1245507938",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 133",
"city": "SHISHMAREF",
"state": "AK",
"postal_code": "997720133",
"telephone_number": "907-649-3311",
"fax_number": "907-649-2083"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "133 LAGOON STREET",
"city": "SHISHMAREF",
"state": "AK",
"postal_code": "997720133",
"telephone_number": "907-649-3311",
"fax_number": "907-649-2083"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUZUGUK",
"first_name": "STEPHANIE",
"middle_name": "K",
"credential": "CHA IV",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-23",
"last_updated": "2011-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "AK",
"license": "09-1019-IV",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHA IV",
"identifier": "09-1019-IV",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shishmaref, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.