Active NPI
Keriann Shine, RD
- Registered Dietitian
- Anchorage, AK
National Provider Identifier
1841911724
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 199493
- Practice address
- 4320 Diplomacy Dr
Anchorage, AK 99508-5925 - Phone
- (907) 729-8901
- Fax
- (907) 729-8607
- NPI assigned
- Sep 8, 2022
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 199493 | AK | Primary |
Addresses
Primary practice location
4320 Diplomacy Dr
Anchorage, AK 99508-5925
Mailing address
7033 E Tudor Rd
Anchorage, AK 99507-1262
Phone (907) 729-8901
Other practice location 1
2041 Revere Cir
Anchorage, AK 99515-2501
Phone (907) 250-5522
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 199493 | AK | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alaska Native Tribal Health Consortium | Current | Accepting new patients | |
| Shine the Dietitian, LLC | Dietitian, Registered | Current | Accepting new patients |
| Southcentral Foundation | Past | Accepting new patients | |
| Southcentral Foundation | Past | Accepting new patients |
Locations
4315 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1729
4320 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-0000
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 and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Anchorage, AK
- NPI 1255881637
-
- Multi-Specialty Clinic/Center
- Wasilla, AK
- NPI 1386680056
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1662595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663718400000",
"number": "1841911724",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7033 E TUDOR RD",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995071262",
"telephone_number": "907-729-8901",
"fax_number": "907-729-8607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4320 DIPLOMACY DR",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995085925",
"telephone_number": "907-729-8901",
"fax_number": "907-729-8607"
}
],
"practiceLocations": [
{
"address_1": "2041 Revere Cir",
"address_purpose": "LOCATION",
"city": "Anchorage",
"state": "AK",
"postal_code": "995152501",
"country_code": "US",
"telephone_number": "907-250-5522",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHINE",
"first_name": "KERIANN",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-09-08",
"last_updated": "2022-09-21",
"certification_date": "2022-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "AK",
"license": "199493",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"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 Sep 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.