Active NPI
Gwendolyn Heckman
- Community Health Worker
- Pilot Station, AK
National Provider Identifier
1306384151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 15-1373-P
- Practice address
- 5089 Airport Street
Pilot Station, AK 99650 - Phone
- (907) 549-3127
- Fax
- (907) 549-3738
- NPI assigned
- Feb 1, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | |||
| Community Health Worker | 172V00000X | 15-1373-P | AK | Primary |
Addresses
Primary practice location
5089 Airport Street
Pilot Station, AK 99650
Mailing address
436 5TH & Ted Stevens Way
Kotzebue, AK 99752-0043
Phone (907) 442-7161
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 |
|---|---|---|---|
| 15-1373-P | AK | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711324800000",
"number": "1306384151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "436 5TH & TED STEVENS WAY",
"city": "KOTZEBUE",
"state": "AK",
"postal_code": "997520043",
"telephone_number": "907-442-7161",
"fax_number": "907-442-7250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5089 AIRPORT STREET",
"city": "PILOT STATION",
"state": "AK",
"postal_code": "99650",
"telephone_number": "907-549-3127",
"fax_number": "907-549-3738"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HECKMAN",
"first_name": "GWENDOLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-02-01",
"last_updated": "2024-03-25",
"certification_date": "2024-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "AK",
"license": "15-1373-P",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pilot Station, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.