Kathleen Anne Fagan, DNSC, RN, BC, APN

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

26NN09492700 Issued in NJ

Practice address

241 Moore St
Hackensack, NJ 07601-7533

Phone

(201) 342-2478

NPI assigned

Jan 11, 2010

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)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kathleen.fagan.1@24719.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/24719/brand/1/csg/1/fhir/r4

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.

• Bergen Volunteer Medical Initiative

  • Clinic/Center
  • Hackensack, NJ
  • NPI 1972757755
  NPD (past)

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

{
    "created_epoch": "1263168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263168000000",
    "number": "1386974517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "188 DEERFIELD TER",
            "city": "MAHWAH",
            "state": "NJ",
            "postal_code": "074302853",
            "telephone_number": "210-694-7920",
            "fax_number": "201-934-6691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "241 MOORE ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076017533",
            "telephone_number": "201-342-2478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "KATHLEEN",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "DNSC, RN, BC, APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-11",
        "last_updated": "2010-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "NJ",
            "license": "26NN09492700",
            "primary": true
        },
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "NJ",
            "license": "26NN09492700",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Executive Home Care, LLC
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• Douglas Tyler Fabrizio, OTR/L
• Stefan H. Faderl, M.D.
• Nicole M Falcone, DPT
• Daria Marie Falkowitz, D.O
• Alfred M Fam, M.D.
• Caroline S Fan
• Xiaowen Fan, M.D.

• Women's Health Nurse Practitioner in Hackensack, NJ
• Providers in Hackensack, NJ by specialty
• Women's Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 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.

Verify at the official NPI Registry.