Individual provider Active NPI

James Edwin Dickey, FNP

  • Family Nurse Practitioner
  • Kenai, AK
National Provider Identifier
1275516494
Registry record updated Oct 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
7700-162 Issued in AK
Practice address
36105 Reef Dr
Kenai, AK 99611-8767
Phone
(907) 330-9006
NPI assigned
Nov 22, 2005
Last updated
Oct 22, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 7700-162 AK Primary

Addresses

Primary practice location

36105 Reef Dr
Kenai, AK 99611-8767

Mailing address

36105 Reef Dr
Kenai, AK 99611-8767
Phone (907) 330-9006

Other practice location 1

508 Upland St
Kenai, AK 99611-8026
Phone (907) 335-7500

Other identifiers 1

IdentifierTypeStateIssuer
1748037MedicaidAK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241119002993 TX Practitioner - Nurse Practitioner 5395188973 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tanana Chiefs ConferenceGroup PAC ID 9537050109, 148 clinicians

Practice addresses (Care Compare)

1717 W Cowles St
Fairbanks, AK 99701-5926
Phone (907) 451-6682

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
7700-162AKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tanana Chiefs Conference CurrentSince Sep 6, 2024 Accepting new patients
Tanana Chiefs Conference CurrentSince Sep 6, 2024 Accepting new patients

Locations

122 1st Ave
Ste 106
Fairbanks, AK 99701

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729555200000",
    "number": "1275516494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36105 REEF DR",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "996118767",
            "telephone_number": "907-330-9006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36105 REEF DR",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "996118767",
            "telephone_number": "907-330-9006"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "508 Upland St",
            "address_purpose": "LOCATION",
            "city": "Kenai",
            "state": "AK",
            "postal_code": "996118026",
            "country_code": "US",
            "telephone_number": "907-335-7500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKEY",
        "first_name": "JAMES",
        "middle_name": "EDWIN",
        "name_prefix": "Mr.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-22",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AK",
            "license": "7700-162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1748037",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenai, AK

Sources for this page

Verify at the official NPI Registry.