Shasta Petersen, LMT

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

2091 Waldron Dr
Anchorage, AK 99507-1343

Phone

(208) 244-2962

NPI assigned

Oct 27, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1477526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477526400000",
    "number": "1841742616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 231332",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995231332",
            "telephone_number": "208-604-4263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2091 WALDRON DR",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995071343",
            "telephone_number": "208-244-2962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "SHASTA",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-27",
        "last_updated": "2016-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy Peters
• Anneliese R Petersen, MD
• Eric Petersen
• Joseph Taylor Petersen
• Lennett Petersen, APRN
• Mackenzie Peterson Willingham, MHS
• Jessica Marie Peterson-Peschang, LMT
• Darrell J Peterson, D.D.S.
• Davis C Peterson, M.D.
• Denali Peterson

• Community Health Worker in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Community Health Worker in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; 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.