Active NPI
Breanna Mackay
- Community Health Worker
- Kenai, AK
National Provider Identifier
1295696573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 508 Upland St
Kenai, AK 99611-8026 - Phone
- (907) 335-7500
- NPI assigned
- Nov 18, 2025
- 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 | Primary |
Addresses
Primary practice location
508 Upland St
Kenai, AK 99611-8026
Mailing address
PO Box 988
Kenai, AK 99611-0988
Phone (907) 335-7500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1761120 | Medicaid | AK |
Other names 1
- Breanna Fossum
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": "1763424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1766966400000",
"number": "1295696573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 988",
"city": "KENAI",
"state": "AK",
"postal_code": "996110988",
"telephone_number": "907-335-7500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "508 UPLAND ST",
"city": "KENAI",
"state": "AK",
"postal_code": "996118026",
"telephone_number": "907-335-7500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACKAY",
"first_name": "BREANNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-11-18",
"last_updated": "2025-12-29",
"certification_date": "2025-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1761120",
"state": "AK"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "BREANNA",
"last_name": "FOSSUM",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Kenai, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.