Active NPI
Kristina Marie Hernandez McDougall
- Community Health Worker
- Sheridan, WY
National Provider Identifier
1639430663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 151 W. Brundage St.
Sheridan, WY 82801 - Phone
- (307) 674-1668
- NPI assigned
- Jun 6, 2012
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
151 W. Brundage St.
Sheridan, WY 82801
Mailing address
493 Brook St
PO Box 166
Ranchester, WY 82839
Phone (307) 683-6414
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740318013 | Other | WY | NPI# |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338940800000",
"number": "1639430663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "493 BROOK ST",
"address_2": "PO BOX 166",
"city": "RANCHESTER",
"state": "WY",
"postal_code": "82839",
"telephone_number": "307-683-6414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "151 W. BRUNDAGE ST.",
"city": "SHERIDAN",
"state": "WY",
"postal_code": "82801",
"telephone_number": "307-674-1668"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERNANDEZ MCDOUGALL",
"first_name": "KRISTINA",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-06",
"last_updated": "2012-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI#",
"identifier": "1740318013",
"state": "WY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sheridan, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.