Nettie O. L. Irwin, MD
Individual provider Active NPI Pediatrics Physician · Fairbanks, AK
NPI 1801475314 · NPPES record last updated Jun 12, 2025
Key facts
- NPI
- 1801475314
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 228059 (AK)
- Practice address
- 1650 Cowles St
Fairbanks, AK 99701-5907 - Phone
- (907) 459-3520
- Fax
- (907) 459-3554
- NPI assigned
- Apr 3, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250211001341 | AK | Practitioner - Pediatric Medicine | 9739563685 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 228059 | AK | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tanana Valley Clinic LLC | Current |
Accepting new patients | |
| Tanana Valley Clinic LLC | Current |
Accepting new patients |
Locations
1650 Cowles St
Fairbanks, AK 99701
Phone (907) 452-8181
1650 Cowles St
Fl 4
Fairbanks, AK 99701
1001 Noble St
Fairbanks, AK 99701
Phone (907) 276-2806
Interoperability endpoints
- nettie.irwin@direct.tananavalley.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 12974710-1205 | UT | |
| Pediatrics Physician | 208000000X | 228059 | AK | Yes |
Addresses
Primary practice location
1650 Cowles St
Fairbanks, AK 99701-5907
Mailing address
PO Box 73720
Fairbanks, AK 99707-3720
Phone (907) 459-3520
Other practice location 1
81 N Mario Capecchi Dr
Salt Lake City, UT 84113-1125
Phone (801) 662-5700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1752819 | Medicaid | AK |
Other names
- Nettie O. Irwin
Other providers in Fairbanks, AK
- Rosalia Ioane
- Christina Marie Ireton
- Edward Irish
- Ironlight Behavioral Health Services, LLC
- Jodi Ann Irvine
- Hisako Ito
- Donald Ives
- Precious Eyewumi Izeagi
- Jace LLC
- Amani Ayisha Jackson
All providers in Fairbanks, AK · Pediatrics Physician in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.