Desiree Marie Davison, CHA-T

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

1000 Greg Krushek Ave
Nome, AK 99762-9976

Phone

(907) 890-3311

Fax

(907) 890-2280

NPI assigned

Aug 27, 2021

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 27, 2021.

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630022400000",
    "number": "1508533407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 69",
            "city": "ELIM",
            "state": "AK",
            "postal_code": "997390069",
            "telephone_number": "907-890-3311",
            "fax_number": "907-890-2280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 GREG KRUSHEK AVE",
            "city": "NOME",
            "state": "AK",
            "postal_code": "997629976",
            "telephone_number": "907-890-3311",
            "fax_number": "907-890-2280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVISON",
        "first_name": "DESIREE",
        "middle_name": "MARIE",
        "credential": "CHA-T",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-27",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "AK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHA-T",
            "identifier": "CHA-T",
            "state": "AK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Elim",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Elim",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Elim",
            "address_1": "1000 GREG KRUSHEK AVE",
            "city": "Nome",
            "state": "AK",
            "country_code": "US",
            "postal_code": "99762",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stephen Darrell Daniel, M.D.
• Anika Darcus
• Jerry M. Davenport, D. O.
• Jay David, L.C.S.W.
• Yonaton Sahar Davidson
• Rochelle Lanae Davison, CHA-T
• Jennifer R Dean-Johnson
• Scott Russell Dickinson, RN
• Jennie Diggs
• Raymond Michael Droby, PH.D.

• All providers in Nome, AK
• Community Health Worker in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; 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.