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MOOSE CREEK MEDICAL CLINIC LLC
NPI 1053883595
Nurse Practitioner - Adult Health in Wasilla, AK

Active since December 21, 2018CLIA 02D2165694 · Microscopy
2341 S. FERN ST., SUITE 300, WASILLA, AK 99654(907) 373-3335(907) 373-3331 Get Directions Write a Review

NPPES record last updated: December 21, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Moose Creek Medical Clinic Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MOOSE CREEK MEDICAL CLINIC LLC (NPI 1053883595) is a healthcare organization registered as an adult health in Wasilla, Alaska and active in the NPI registry since December 2018. The organization holds a CLIA Microscopy certificate valid through May 2, 2027 and lists Kimberli Raye Brock, Advanced Nurse Practitioner, Busine, as its authorized official.

NPPES Registry Identity

NPI1053883595
Entity TypeOrganization
Primary Taxonomy363LA2200X
Legal Business NameMOOSE CREEK MEDICAL CLINIC LLC
Location Address2341 S. FERN ST., SUITE 300Wasilla, AK 99654
Mailing Address2341 S. Fern St., Suite 300Wasilla, AK 99654 · (907) 373-3335 · Fax (907) 373-3331
Phone(907) 373-3335
Fax(907) 373-3331
Organization SubpartNo
Authorized OfficialKimberli Raye BrockAdvanced Nurse Practitioner, Busine · (907) 373-3335
Enumeration DateDecember 21, 2018
✔ NPI 1053883595 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse Practitioner · Adult HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2200X
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
Also ListedNurse Practitioner · Women's HealthTaxonomy 363LW0102X
2341 S. FERN ST., SUITE 300, Wasilla, AK 99654
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Other Identifiers 1

Medicaid1022256AK

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., Premera Blue Cross Blue Shield of Alaska.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 02D2165694

Moose Creek Medical Clinic, LLC · Wasilla, AK
Active · expires May 2, 2027
CLIA Number02D2165694
Laboratory TypePractitioner Other
Certificate Effective DateMay 3, 2025
Certificate Expiration DateMay 2, 2027
Laboratory DirectorKymberli R. Brock
Laboratory Phone(907) 373-3335
Laboratory LocationMoose Creek Medical Clinic, LLC211 E Fairview Loop, Wasilla, AK 99654
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Moose Creek Medical Clinic LLC's NPI number?

The NPI number for Moose Creek Medical Clinic LLC is 1053883595. It was assigned to this organization in the NPPES registry on December 21, 2018.

Where is Moose Creek Medical Clinic LLC located?

Moose Creek Medical Clinic LLC is located at 2341 S. Fern St., Suite 300, Wasilla, AK 99654. The listed phone number is (907) 373-3335.

What is Moose Creek Medical Clinic LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.

Does Moose Creek Medical Clinic LLC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 02D2165694) is associated with this NPI, valid through May 2, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Moose Creek Medical Clinic LLC accept?

Health plans from Moda Health Plan, Inc. and Premera Blue Cross Blue Shield of Alaska list Moose Creek Medical Clinic LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Moose Creek Medical Clinic LLC was last updated on December 21, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.