NPIMap

Individual provider Active NPI

Bethani Ann Shepard

  • Personal Care Attendant
  • Kenai, AK
National Provider Identifier
1730827114
Registry record updated Apr 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Personal Care AttendantTaxonomy code 3747P1801X
Practice address
130 S. Willow St.
#9
Kenai, AK 99611
Phone
(907) 283-0085
Fax
(907) 283-0084
NPI assigned
May 25, 2022
Last updated
Apr 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Day Training/Habilitation Specialist 373H00000X
Personal Care Attendant 3747P1801X Primary
Peer Specialist 175T00000X AK
Behavior Technician 106S00000X

Addresses

Primary practice location

130 S. Willow St.
#9
Kenai, AK 99611

Mailing address

130 S. Willow St. #9
#9
Kenai, AK 99611
Phone (907) 283-0085

Other practice location 1

354 Tyee St
Soldotna, AK 99669-7657
Phone (907) 714-5870

Other practice location 2

250 Hospital Pl
Soldotna, AK 99669-7559
Phone (907) 714-4404

Other practice location 3

47480 Kristina Way
Kenai, AK 99611-5902
Phone (907) 714-4519

Other practice location 4

362 Tyee St
Soldotna, AK 99669-7631
Phone (907) 714-4521

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bshepard2348085@ak.providencedirect.org

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

Practice roles

OrganizationSpecialtyStatusNew patients
Central Peninsula General Hospital, Inc Past Accepting new patients
Central Peninsula General Hospital, Inc Past Accepting new patients
Central Peninsula General Hospital, Inc PastSince Oct 25, 2020 Accepting new patients
Central Peninsula General Hospital Inc Past Accepting new patients
Central Peninsula General Hospital, Inc PastSince Dec 13, 2020 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: bshepard2348085@ak.providencedirect.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1653436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712534400000",
    "number": "1730827114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 S. WILLOW ST. #9",
            "address_2": "#9",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "99611",
            "telephone_number": "907-283-0085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 S. WILLOW ST.",
            "address_2": "#9",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "99611",
            "telephone_number": "907-283-0085",
            "fax_number": "907-283-0084"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "354 Tyee St",
            "address_purpose": "LOCATION",
            "city": "Soldotna",
            "state": "AK",
            "postal_code": "996697657",
            "country_code": "US",
            "telephone_number": "907-714-5870",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "250 Hospital Pl",
            "address_purpose": "LOCATION",
            "city": "Soldotna",
            "state": "AK",
            "postal_code": "996697559",
            "country_code": "US",
            "telephone_number": "907-714-4404",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "47480 Kristina Way",
            "address_purpose": "LOCATION",
            "city": "Kenai",
            "state": "AK",
            "postal_code": "996115902",
            "country_code": "US",
            "telephone_number": "907-714-4519",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "362 Tyee St",
            "address_purpose": "LOCATION",
            "city": "Soldotna",
            "state": "AK",
            "postal_code": "996697631",
            "country_code": "US",
            "telephone_number": "907-714-4521",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHEPARD",
        "first_name": "BETHANI",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-25",
        "last_updated": "2024-04-08",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "373H00000X",
            "taxonomy_group": "",
            "desc": "Day Training/Habilitation Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "AK",
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bshepard2348085@ak.providencedirect.org",
            "affiliation": "N",
            "endpointDescription": "direct message",
            "address_1": "245 N Binkley St Ste 202",
            "city": "Soldotna",
            "state": "AK",
            "country_code": "US",
            "postal_code": "996697500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kenai, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2024; 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.