Active NPI
Kathryn Susan Eisenmenger Fuentes, PA
- Physician Assistant
- Eagan, MN
National Provider Identifier
1306149539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1514
- Practice address
- 2854 Highway 55
Suite 130
Eagan, MN 55121-2156 - Phone
- (651) 842-3320
- Fax
- (651) 224-5273
- NPI assigned
- Dec 9, 2010
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1514 | MN | Primary |
Addresses
Primary practice location
2854 Highway 55
Suite 130
Eagan, MN 55121-2156
Mailing address
2854 Highway 55
Suite 130
Eagan, MN 55121-2156
Phone (651) 842-3320
Other names 1
- Kathryn Susan Eisenmenger
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1514 | MN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carbon Health Medical Group of California PC | Past | Accepting new patients |
Interoperability endpoints
- kathryn.fuentes@811393367080964.direct.elationemr.com
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.
-
dba Carbon Health
- Urgent Care Clinic/Center
- Pasadena, CA
- NPI 1255957205
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292198400000",
"number": "1306149539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2854 HIGHWAY 55",
"address_2": "SUITE 130",
"city": "EAGAN",
"state": "MN",
"postal_code": "551212156",
"telephone_number": "651-842-3320",
"fax_number": "651-224-5273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2854 HIGHWAY 55",
"address_2": "SUITE 130",
"city": "EAGAN",
"state": "MN",
"postal_code": "551212156",
"telephone_number": "651-842-3320",
"fax_number": "651-224-5273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EISENMENGER FUENTES",
"first_name": "KATHRYN",
"middle_name": "SUSAN",
"name_prefix": "Ms.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-12-09",
"last_updated": "2010-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "1514",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KATHRYN",
"last_name": "EISENMENGER",
"middle_name": "SUSAN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Eagan, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.