Theresa F Nielsen, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP128179 Issued in TX

Practice address

2960 Tongass Ave
Ketchikan, AK 99901-5742

Phone

(907) 228-4900

Fax

(800) 852-3264

NPI assigned

Nov 13, 2006

Last updated

Sep 6, 2016By 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 identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Open Door Community Health Centers

  dba Del Norte Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Crescent City, CA
  • NPI 1497840656
  Medicare reassignment NPD
• Open Door Community Health Centers

  dba Humboldt Open Door Clinic

  • Federally Qualified Health Center (FQHC)
  • Arcata, CA
  • NPI 1255435533
  NPD
• Open Door Community Health Centers

  dba Fortuna Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Fortuna, CA
  • NPI 1306252051
  NPD
• Open Door Community Health Centers

  dba McKinleyville Community Health Center

  • Federally Qualified Health Center (FQHC)
  • McKinleyville, CA
  • NPI 1598858169
  NPD
• Open Door Community Health Centers

  dba Willow Creek Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Willow Creek, CA
  • NPI 1730330739
  NPD
• Open Door Community Health Centers

  dba Open Door Downtown

  • Federally Qualified Health Center (FQHC)
  • Eureka, CA
  • NPI 1831713452
  NPD

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473120000000",
    "number": "1851462717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2960 TONGASS AVE",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015742",
            "telephone_number": "907-228-4900",
            "fax_number": "800-852-3264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2960 TONGASS AVE",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015742",
            "telephone_number": "907-228-4900",
            "fax_number": "800-852-3264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELSEN",
        "first_name": "THERESA",
        "middle_name": "F",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2016-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP128179",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "6696",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1851462717",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cara Siena Nguyen, PSY.D.
• Amy J. Nichols, M.D.
• Daryl Nichols
• Angela Nickich
• Danielle Lynn Nickich
• Seong J Noh, M.D., PHD
• Lisa C Noland
• Thomas B Nordtvedt, DDS
• Northway Family Healthcare
• Maureen Northway, FNP-C

• Family Nurse Practitioner in Ketchikan, AK
• Providers in Ketchikan, AK by specialty
• Family Nurse Practitioner in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2016; 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.