Active NPI
Crystal Venkov
- Licensed Practical Nurse
- Anchorage, AK
National Provider Identifier
1770888018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 115608
- Practice address
- 4315 Diplomacy Dr
Anchorage, AK 99508-5926 - Phone
- (907) 770-0863
- NPI assigned
- Jan 18, 2011
- Reactivated
- Jan 18, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 115608 | AK | Primary |
Addresses
Primary practice location
4315 Diplomacy Dr
Anchorage, AK 99508-5926
Mailing address
4315 Diplomacy Dr
Anchorage, AK 99508-5926
Phone (907) 770-0863
Other practice location 1
722 second avenue
kotzebue, AK 99752
Phone (907) 442-7640 ext. 7647
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | connect |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 115608 | AK | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610928000000",
"number": "1770888018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4315 DIPLOMACY DR",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995085926",
"telephone_number": "907-770-0863"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4315 DIPLOMACY DR",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995085926",
"telephone_number": "907-770-0863"
}
],
"practiceLocations": [
{
"address_1": "722 second avenue",
"address_purpose": "LOCATION",
"city": "kotzebue",
"state": "AK",
"postal_code": "99752",
"country_code": "US",
"telephone_number": "907-442-7640 x7647",
"fax_number": "907-442-7749",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VENKOV",
"first_name": "CRYSTAL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-01-18",
"last_updated": "2021-01-18",
"certification_date": "2021-01-18",
"deactivation_date": "2020-09-21",
"reactivation_date": "2021-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "AK",
"license": "115608",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "connect",
"affiliation": "N",
"address_1": "4315 Diplomacy Dr",
"city": "Anchorage",
"state": "AK",
"country_code": "US",
"postal_code": "995085926",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Anchorage, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.