Kathleen Eagle, MSN, APRN, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

009880 Issued in CT

Practice address

620 Norwich New London Tpke
Uncasville, CT 06382-2156

Phone

(860) 892-8012

Fax

(860) 892-8027

NPI assigned

Sep 7, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT, NH2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

State licenses

Practice roles

Locations

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.

• Balanced Wellness Primary Care, LLC

  • Family Nurse Practitioner
  • Uncasville, CT
  • NPI 1780926774
  Medicare reassignment NPD
• Community Care Health Network LLC

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1619368842

  NH

  Medicare reassignment NPD
• Matrix Medical Plus

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1376973461

  CT

  Medicare reassignment NPD

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

{
    "created_epoch": "1630972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630972800000",
    "number": "1275202087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "432 THREE CORNERS RD",
            "city": "GUILFORD",
            "state": "CT",
            "postal_code": "064372531",
            "telephone_number": "860-798-5040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 NORWICH NEW LONDON TPKE",
            "city": "UNCASVILLE",
            "state": "CT",
            "postal_code": "063822156",
            "telephone_number": "860-892-8012",
            "fax_number": "860-892-8027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EAGLE",
        "first_name": "KATHLEEN",
        "credential": "MSN, APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-07",
        "last_updated": "2021-09-07",
        "certification_date": "2021-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "009880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carly Rae Delcore
• Peter W. Derosa, LPC
• Deborah Elizabeth Donat, APRN
• Diane Donatello
• Alyce Elena Dow, OT
• El Shaddai Home Care Agency LLC
• Jennifer Melissa Feeney, DC
• Donald J Felitto, MD
• Morgan Fenner
• Luke Ferrin

• Family Nurse Practitioner in Uncasville, CT
• Providers in Uncasville, CT by specialty
• Family Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.