Nettie O. L. Irwin, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

228059 Issued in AK

Practice address

1650 Cowles St
Fairbanks, AK 99701-5907

Phone

(907) 459-3520

Fax

(907) 459-3554

NPI assigned

Apr 3, 2021

Last updated

Jun 12, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Nettie O. Irwin Former name

Medicare fee-for-service enrollment

Enrolled in AK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nettie.irwin@direct.tananavalley.nextgenshare.com

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.

• Tanana Valley Clinic LLC

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
  • NPI 1922559558
  Medicare reassignment NPD
• Tanana Valley Clinic LLC

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
  • NPI 1073081485
  NPD

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

{
    "created_epoch": "1617408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749686400000",
    "number": "1801475314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 73720",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997073720",
            "telephone_number": "907-459-3520",
            "fax_number": "907-459-3554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 COWLES ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015907",
            "telephone_number": "907-459-3520",
            "fax_number": "907-459-3554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "81 N Mario Capecchi Dr",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841131125",
            "country_code": "US",
            "telephone_number": "801-662-5700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IRWIN",
        "first_name": "NETTIE",
        "middle_name": "O. L.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-03",
        "last_updated": "2025-06-12",
        "certification_date": "2025-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "12974710-1205",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AK",
            "license": "228059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NETTIE",
            "last_name": "IRWIN",
            "middle_name": "O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rosalia Ioane
• Christina Marie Ireton, LCSW
• Edward Irish, RBT
• Ironlight Behavioral Health Services, LLC
• Jodi Ann Irvine
• Hisako Ito, NCTMB/MPL
• Donald Ives, M.D.
• Precious Eyewumi Izeagi, MSN, APRN, PMHNP-BC
• Jace LLC
• Amani Ayisha Jackson

• Pediatrics Physician in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Pediatrics Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.