Joseph Charles Vickrey

Key facts

NPI

1689438376

Entity type

Individual (NPI type 1)

Primary specialty

Day Training/Habilitation Specialist 373H00000X

Practice address

1401 S Seward Meridian Pkwy # Abc
Wasilla, AK 99654-8312

Phone

(907) 631-3520

NPI assigned

Feb 12, 2024

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 12, 2024.

{
    "created_epoch": "1707696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707696000000",
    "number": "1689438376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 E 74TH AVE",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995072614",
            "telephone_number": "907-929-5826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 S SEWARD MERIDIAN PKWY # ABC",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996548312",
            "telephone_number": "907-631-3520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICKREY",
        "first_name": "JOSEPH",
        "middle_name": "CHARLES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-12",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "373H00000X",
            "taxonomy_group": "",
            "desc": "Day Training/Habilitation Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Wasilla, AK · Day Training/Habilitation Specialist in Alaska