NPIMap

Individual provider Active NPI

Amy Margaret Wunnicke

  • Peer Specialist
  • Soldotna, AK
National Provider Identifier
1790391142
Registry record updated Nov 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Peer SpecialistTaxonomy code 175T00000X
Practice address
245 N Binkley St Ste 202
Soldotna, AK 99669-7500
Phone
(907) 714-4521
NPI assigned
Sep 21, 2020
Last updated
Nov 23, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Peer Specialist 175T00000X NU Primary

Addresses

Primary practice location

245 N Binkley St Ste 202
Soldotna, AK 99669-7500

Mailing address

PO Box 1290
Homer, AK 99603-1290

Other practice location 1

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

Other practice location 2

47480 Kristina Way
Kenai, AK 99611-5902
Phone (907) 714-4521

Other practice location 3

354 Tyee St
Soldotna, AK 99669-7657
Phone (907) 714-4521

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address awunnicke1154329@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 PastSince Dec 13, 2020 Accepting new patients

Organizations & group practices 4

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": "1600646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606089600000",
    "number": "1790391142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1290",
            "city": "HOMER",
            "state": "AK",
            "postal_code": "996031290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 N BINKLEY ST STE 202",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996697500",
            "telephone_number": "907-714-4521"
        }
    ],
    "practiceLocations": [
        {
            "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"
        },
        {
            "address_1": "47480 Kristina Way",
            "address_purpose": "LOCATION",
            "city": "Kenai",
            "state": "AK",
            "postal_code": "996115902",
            "country_code": "US",
            "telephone_number": "907-714-4521",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "354 Tyee St",
            "address_purpose": "LOCATION",
            "city": "Soldotna",
            "state": "AK",
            "postal_code": "996697657",
            "country_code": "US",
            "telephone_number": "907-714-4521",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WUNNICKE",
        "first_name": "AMY",
        "middle_name": "MARGARET",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-21",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "awunnicke1154329@ak.providencedirect.org",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "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 Soldotna, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; 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.