Active NPI
Katie Eagan, M.D.
- Speech-Language Pathologist
- Davenport, FL
National Provider Identifier
1275074718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA13175
- Practice address
- 823 Caribbean Dr
Davenport, FL 33897-3942 - Phone
- (618) 973-5397
- Fax
- (352) 432-3999
- NPI assigned
- Mar 16, 2017
- Last updated
- Mar 16, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SA13175 | FL | Primary |
Addresses
Primary practice location
823 Caribbean Dr
Davenport, FL 33897-3942
Mailing address
823 Caribbean Dr
Davenport, FL 33897-3942
Phone (618) 973-5397
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA13175 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489622400000",
"number": "1275074718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "823 CARIBBEAN DR",
"city": "DAVENPORT",
"state": "FL",
"postal_code": "338973942",
"telephone_number": "618-973-5397",
"fax_number": "352-432-3999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "823 CARIBBEAN DR",
"city": "DAVENPORT",
"state": "FL",
"postal_code": "338973942",
"telephone_number": "618-973-5397",
"fax_number": "352-432-3999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EAGAN",
"first_name": "KATIE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-16",
"last_updated": "2017-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA13175",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davenport, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.