Alysha Delphine Enbom

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN-4642 Issued in HI

Practice address

PO Box 624
Hanapepe, HI 96716-0624

Phone

(360) 301-5568

NPI assigned

May 15, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other names 1

• Alysha Delphine Hartshorn Former name

Medicare fee-for-service enrollment

Enrolled in HI

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

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Kauai Medical ClinicGroup PAC ID 5092628479, 147 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wilcox Memorial Hospital Hospital, Lihue, HI, CCN 120014

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kauai Medical Clinic

  • Multi-Specialty Clinic/Center
  • Lihue, HI
  • NPI 1376596643
  Medicare reassignment Care Compare group NPD
• Hoola Lahui Hawaii

  • Federally Qualified Health Center (FQHC)
  • Waimea, HI
  • NPI 1245269976
  Medicare reassignment NPD
• Kapiolani Medical Center for Women & Children

  • Multi-Specialty Clinic/Center
  • Honolulu, HI
  • NPI 1548215692
  Medicare reassignment NPD
• Straub Clinic & Hospital

  dba Straub Benioff Medical Center

  • Multi-Specialty Clinic/Center
  • Honolulu, HI
  • NPI 1457306508
  Medicare reassignment NPD
• Hoola Lahui Hawaii

  • Federally Qualified Health Center (FQHC)
  • Kapa'a, HI
  • NPI 1891098513
  NPD
• Kapiolani Medical Center for Women & Children

  dba Kapiolani Medical Center Outpatient Pharmacy

  • Community/Retail Pharmacy
  • Honolulu, HI
  • NPI 1841263720
  NPD
• Kauai Medical Clinic

  • Durable Medical Equipment & Medical Supplies
  • Koloa, HI
  • NPI 1871611558
  NPD
• Straub Clinic & Hospital

  dba Hawaii Pacific Health Specialty Pharmacy

  • Community/Retail Pharmacy
  • Honolulu, HI
  • NPI 1295443216
  NPD
• Kapiolani Medical Center

  • Children's Hospital
  • Pearl City, HI
  • NPI 1083810840
  NPD (past)
• Kapiolani Medical Center for Women & Children

  • Children's Hospital
  • Honolulu, HI
  • NPI 1043263080
  NPD (past)
• Straub Clinic & Hospital

  • Durable Medical Equipment & Medical Supplies
  • Honolulu, HI
  • NPI 1851443733
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Wilcox Memorial Hospital

  • Rural Acute Care Hospital
  • Lihue, HI
  • NPI 1225113442
  Care Compare affiliation

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

{
    "created_epoch": "1715731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719360000000",
    "number": "1457100299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 624",
            "city": "HANAPEPE",
            "state": "HI",
            "postal_code": "967160624",
            "telephone_number": "360-301-5568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 624",
            "city": "HANAPEPE",
            "state": "HI",
            "postal_code": "967160624",
            "telephone_number": "360-301-5568"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1204 N Vercler Rd",
            "address_purpose": "LOCATION",
            "city": "Spokane Valley",
            "state": "WA",
            "postal_code": "992161020",
            "country_code": "US",
            "telephone_number": "509-228-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ENBOM",
        "first_name": "ALYSHA",
        "middle_name": "DELPHINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-15",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ID",
            "license": "55667",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN61092439",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "HI",
            "license": "103027",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "HI",
            "license": "APRN-4642",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALYSHA",
            "last_name": "HARTSHORN",
            "middle_name": "DELPHINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Family Nurse Practitioner in Hanapepe, HI
• Providers in Hanapepe, HI by specialty
• Family Nurse Practitioner in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.