Individual provider Active NPI

Colter Travis Jensen-Dykes

  • Student in an Organized Health Care Education/Training Program
  • Fairbanks, AK
National Provider Identifier
1316845829
Registry record updated Oct 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1007 N Chandalar Drive
Room 206, Whitaker Building
Fairbanks, AK 99775-0001
Phone
(907) 474-7043
NPI assigned
Oct 27, 2026
Last updated
Oct 27, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 27, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1007 N Chandalar Drive
Room 206, Whitaker Building
Fairbanks, AK 99775-0001

Mailing address

86457 Greenbriar Dr
Eugene, OR 97402-9000
Phone (458) 322-6815

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": "1793059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1793059200000",
    "number": "1316845829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86457 GREENBRIAR DR",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974029000",
            "telephone_number": "458-322-6815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 N CHANDALAR DRIVE",
            "address_2": "ROOM 206, WHITAKER BUILDING",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997750001",
            "telephone_number": "907-474-7043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN-DYKES",
        "first_name": "COLTER",
        "middle_name": "TRAVIS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2026-10-27",
        "last_updated": "2026-10-27",
        "certification_date": "2026-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.