Individual provider Active NPI

Elise Michelle Shahan, FNP-C

  • Family Nurse Practitioner
  • Fairbanks, AK
National Provider Identifier
1356148647
Registry record updated Feb 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
233874 Issued in AK
Practice address
1353 W Chena Hills Dr
Fairbanks, AK 99709-5752
Phone
(907) 750-9620
NPI assigned
Feb 25, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2025

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 233874 AK Primary

Addresses

Primary practice location

1353 W Chena Hills Dr
Fairbanks, AK 99709-5752

Mailing address

1353 W Chena Hills Dr
Fairbanks, AK 99709-5752
Phone (907) 750-9620

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK
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
I20251010001965 AK Practitioner - Nurse Practitioner 5597175547 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
May accept Medicare assignment
Group practices
Alpine Medical Group LLCGroup PAC ID 7113302373, 9 clinicians

Practice addresses (Care Compare)

2054 30TH Ave
Fairbanks, AK 99701-7316
Phone (907) 455-4555

605 Chief Thomas Dr
Fairbanks, AK 99709-4848
Phone (907) 455-4555

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
233874AKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Alpine Medical Group LLC Family CurrentSince Oct 1, 2025 Accepting new patients

Locations

2054 30th Ave
Fairbanks, AK 99701
Phone (907) 455-4555

605 Chief Thomas Dr
Fairbanks, AK 99709
Phone (907) 455-4555

Interoperability endpoints

  • Direct secure messaging: elise.shahan.1@24993.direct.athenahealth.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1740441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740441600000",
    "number": "1356148647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1353 W CHENA HILLS DR",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997095752",
            "telephone_number": "907-750-9620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1353 W CHENA HILLS DR",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997095752",
            "telephone_number": "907-750-9620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAHAN",
        "first_name": "ELISE",
        "middle_name": "MICHELLE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-25",
        "last_updated": "2025-02-25",
        "certification_date": "2025-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AK",
            "license": "233874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

Verify at the official NPI Registry.