Active NPI
Kathy Agnese, R.N.
- Case Management Registered Nurse
- Clearlake, CA
National Provider Identifier
1003047663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Management Registered Nurse
- License
- 724431
- Practice address
- 14644B Lakeshore Dr
Clearlake, CA 95422-9290 - Phone
- (707) 995-1606
- Fax
- (707) 995-0309
- NPI assigned
- Jul 30, 2009
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Case Management Registered Nurse | 163WC0400X | 724431 | CA | Primary |
Addresses
Primary practice location
14644B Lakeshore Dr
Clearlake, CA 95422-9290
Mailing address
14644B Lakeshore Dr
Clearlake, CA 95422-9290
Phone (707) 995-1606
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 724431 | CA | MD | Case Management Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Care | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Health Maintenance Organization
- Clearlake, CA
- NPI 1669654091
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248912000000",
"number": "1003047663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14644B LAKESHORE DR",
"city": "CLEARLAKE",
"state": "CA",
"postal_code": "954229290",
"telephone_number": "707-995-1606",
"fax_number": "707-995-0309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14644B LAKESHORE DR",
"city": "CLEARLAKE",
"state": "CA",
"postal_code": "954229290",
"telephone_number": "707-995-1606",
"fax_number": "707-995-0309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGNESE",
"first_name": "KATHY",
"name_prefix": "Ms.",
"credential": "R.N.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-30",
"last_updated": "2009-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "163WC0400X",
"taxonomy_group": "",
"desc": "Registered Nurse, Case Management",
"state": "CA",
"license": "724431",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clearlake, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.