Active NPI
Kristin Pacheco
- Speech-Language Pathologist
- Williston, ND
National Provider Identifier
1447424874
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 855
- Practice address
- 1415 W Dakota Pkwy
Williston, ND 58801-3885 - Phone
- (701) 572-6757
- Fax
- (401) 774-3532
- NPI assigned
- Apr 16, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 855 | ND | Primary |
Addresses
Primary practice location
1415 W Dakota Pkwy
Williston, ND 58801-3885
Mailing address
PO Box 1097
Watford City, ND 58854-1097
Phone (701) 444-5221
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 55201 | Medicaid | ND | |
| 855 | Other | ND | STATE LICENSE |
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 |
|---|---|---|---|
| 855 | ND | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208304000000",
"number": "1447424874",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1097",
"city": "WATFORD CITY",
"state": "ND",
"postal_code": "588541097",
"telephone_number": "701-444-5221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1415 W DAKOTA PKWY",
"city": "WILLISTON",
"state": "ND",
"postal_code": "588013885",
"telephone_number": "701-572-6757",
"fax_number": "401-774-3532"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACHECO",
"first_name": "KRISTIN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-16",
"last_updated": "2008-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ND",
"license": "855",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "55201",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "855",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Williston, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.