Madalyn Ticknor

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

1734 Fall Rd
Fairbanks, AK 99709-6727

Phone

(907) 371-4977

NPI assigned

Jul 31, 2023

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

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

{
    "created_epoch": "1690761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690761600000",
    "number": "1689355794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 84813",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997084813",
            "telephone_number": "907-371-4977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1734 FALL RD",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997096727",
            "telephone_number": "907-371-4977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TICKNOR",
        "first_name": "MADALYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-31",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emma Marina Thomsen
• Louis James Thornley, DDS
• Ruth Diane Thorum, LMSW
• Louise Thurmond
• Roger Dean Thurmond, M.D.,P.C.
• Brock Fred Tidstrom, DDS
• Amond Tilley
• Erin R Tilly, RMT, LMT
• Tiffany Rae Timm, PTA
• Caroline Elizabeth Timmerman, MD

• Community Health Worker in Fairbanks, AK
• Providers in Fairbanks, 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 Jul 31, 2023; 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.