Individual provider Active NPI

Thomas Aldebron

  • Driver
  • Wasilla, AK
National Provider Identifier
1912768540
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DriverTaxonomy code 172A00000X
License
49780 Issued in AK
Practice address
307 E Kalli Cir Apt 4
Wasilla, AK 99654-6414
Phone
(907) 331-8695
NPI assigned
Jan 22, 2024
Last updated
Jan 22, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Driver 172A00000X 49780 AK Primary

Addresses

Primary practice location

307 E Kalli Cir Apt 4
Wasilla, AK 99654-6414

Mailing address

307 E Kalli Cir Apt 4
Wasilla, AK 99654-6414
Phone (907) 331-8695

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
49780AKMDDriver

NPI Registry JSON

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

{
    "created_epoch": "1705881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1912768540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 E KALLI CIR APT 4",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996546414",
            "telephone_number": "907-331-8695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 E KALLI CIR APT 4",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996546414",
            "telephone_number": "907-331-8695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALDEBRON",
        "first_name": "THOMAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-01-22",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "AK",
            "license": "49780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wasilla, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; 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.