Kristen E. Flack, AGNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

NP95007308 Issued in CA

Practice address

1540 Florida Ave
Modesto, CA 95350-4430

Phone

(209) 238-4800

Fax

(209) 238-4890

NPI assigned

Aug 21, 2017

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kristen.flacknp.p14@direct.regal.nextgenshare.com
• Direct secure messaging: kristen.flack.1@29991.direct.athenahealth.com

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.

• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Modesto, CA
  • NPI 1700282175
  NPD (past)

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

{
    "created_epoch": "1503273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505433600000",
    "number": "1144746140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 CUSTOMER CARE WAY",
            "city": "ATWATER",
            "state": "CA",
            "postal_code": "953015167",
            "telephone_number": "209-384-6493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 FLORIDA AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504430",
            "telephone_number": "209-238-4800",
            "fax_number": "209-238-4890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLACK",
        "first_name": "KRISTEN",
        "middle_name": "E.",
        "name_prefix": "Mrs.",
        "credential": "AGNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-21",
        "last_updated": "2017-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "RN95078988",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "NP95007308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fitzpatrick ,Mary,DDS Inc
• Dale Walter Fitzpatrick, MD
• Mary Lou Fitzpatrick, DDS
• Michael Edward Fitzpatrick, M.D.
• Five Leaf Colver Trucking LLC
• Francis R Flaim, MD
• Rebecca Flanagan, D.O.
• Andrea Fleming
• Beatriz Fleming
• Gina Fleming

• Gerontology Nurse Practitioner in Modesto, CA
• Providers in Modesto, CA by specialty
• Gerontology Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2017; 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.