Chrystal Marie Moon, CHA IV

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

16-1387-IV Issued in AK

Practice address

100 Pumphouse Road
Tyonek, AK 99682

Phone

(907) 583-2461

Fax

(907) 583-2155

NPI assigned

Mar 8, 2016

Last updated

Oct 31, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1457395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1407217268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7033 E TUDOR RD",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995071262",
            "telephone_number": "907-729-6799",
            "fax_number": "907-729-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PUMPHOUSE ROAD",
            "city": "TYONEK",
            "state": "AK",
            "postal_code": "99682",
            "telephone_number": "907-583-2461",
            "fax_number": "907-583-2155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "CHRYSTAL",
        "middle_name": "MARIE",
        "credential": "CHA IV",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-08",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "AK",
            "license": "16-1387-IV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Native Village of Tyonek
• Southcentral Foundation (Indian Creek BSD Clinic)
• Southcentral Foundation (Tribal- Indian Creek Health Center)
• Southcentral Foundation (Dental- Indian Creek Dental Clinic)
• Robert Anthony Stephan Jr.

• Community Health Worker in Tyonek, AK
• Providers in Tyonek, AK by specialty
• Community Health Worker in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 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.

Verify at the official NPI Registry.