Active NPI
Shawn Adele Roberts, MS FNP
- Family Nurse Practitioner
- Wasilla, AK
National Provider Identifier
1295878429
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 166
- Practice address
- 950 E Bogard Rd
Suite 103
Wasilla, AK 99654-7184 - Phone
- (907) 352-2880
- Fax
- (907) 352-2885
- NPI assigned
- Feb 15, 2007
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 166 | AK | Primary |
Addresses
Primary practice location
950 E Bogard Rd
Suite 103
Wasilla, AK 99654-7184
Mailing address
22626 Lake Hill Dr.
Chugiak, AK 99567
Phone (907) 440-6450
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0166-02 | Medicaid | AK |
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)
- Enrolled
- Credentials
- Master of Science, Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Guardian Flight Inc | Past | Accepting new patients | |
| Raymond E. Andreassen | Past | Accepting new patients | |
| Tok Clinic, LLC | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Rural Health Clinic/Center
- Denali, AK
- NPI 1477726644
-
- Family Medicine Physician
- Delta Junction, AK
- NPI 1366640070
-
- Family Medicine Physician
- Tok, AK
- NPI 1043417959
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365120000000",
"number": "1295878429",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22626 LAKE HILL DR.",
"city": "CHUGIAK",
"state": "AK",
"postal_code": "99567",
"telephone_number": "907-440-6450",
"fax_number": "907-688-8453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "950 E BOGARD RD",
"address_2": "SUITE 103",
"city": "WASILLA",
"state": "AK",
"postal_code": "996547184",
"telephone_number": "907-352-2880",
"fax_number": "907-352-2885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "SHAWN",
"middle_name": "ADELE",
"name_prefix": "Ms.",
"credential": "MS FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-15",
"last_updated": "2013-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AK",
"license": "166",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0166-02",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wasilla, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.