Organization Active NPI

Power of Wellness Health Services LLC

  • Primary Care Nurse Practitioner
  • Ketchikan, AK
National Provider Identifier
1720635840
Registry record updated Nov 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
POWER OF WELLNESS HEALTH SERVICES LLC
Practice address
3528 Tongass Ave
Ketchikan, AK 99901-5635
Phone
(907) 220-4447
Fax
(907) 247-8782
NPI assigned
Aug 22, 2019
Last updated
Nov 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2020

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

Authorized official

Name
Amanda Hulstine, APRNNPI 1306363734
Title
Owner/Provider
Phone
(866) 243-7203

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X NU Primary

Addresses

Primary practice location

3528 Tongass Ave
Ketchikan, AK 99901-5635

Mailing address

PO Box 7691
Ketchikan, AK 99901-2691
Phone (866) 243-7203

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200206000871 AK Part B Supplier - Clinic/Group Practice 5597191759 Receives reassigned benefits from 1 practitioner
Practice locations: Ketchikan, AK

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
02D2172658Power of Wellness Health Services, LLC3528 Tongass Ave, Ketchikan, AK 99901Certificate of waiverSep 25, 2027

National Provider Directory

National Provider Directory

Locations

320 Bawden St
Apt 313
Ketchikan, AK 99901
Phone (907) 220-9982

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1566432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606694400000",
    "number": "1720635840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7691",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999012691",
            "telephone_number": "866-243-7203",
            "fax_number": "833-243-7203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3528 TONGASS AVE",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015635",
            "telephone_number": "907-220-4447",
            "fax_number": "907-247-8782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POWER OF WELLNESS HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-22",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A",
        "authorized_official_last_name": "HULSTINE",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "866-243-7203",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ketchikan, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.