Healthcare Provider Details

I. General information

NPI: 1114857844
Provider Name (Legal Business Name): CARSON A WINELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7335 E PALMER WASILLA HWY
PALMER AK
99645-7710
US

IV. Provider business mailing address

PO BOX 876646
WASILLA AK
99687-6646
US

V. Phone/Fax

Practice location:
  • Phone: 907-745-6200
  • Fax: 907-215-3343
Mailing address:
  • Phone: 907-745-6200
  • Fax: 907-215-3343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: