Bobbi Lynn Fagan, PEER SPECIALIST

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

CPSS-305 Issued in NE

Practice address

415 South 25TH Ave
Annex BLD
Omaha, NE 68131

Phone

(402) 715-4226

NPI assigned

Dec 5, 2018

Sex

Female

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1543968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1477024206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4006 IDA ST",
            "address_2": "ALPHA LIFE",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681120257",
            "telephone_number": "531-207-6462",
            "fax_number": "402-999-4786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 SOUTH 25TH AVE",
            "address_2": "ANNEX BLD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68131",
            "telephone_number": "402-715-4226"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4006 Ida St",
            "address_2": "ALPHA LIFE",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681120257",
            "country_code": "US",
            "telephone_number": "531-207-6462",
            "fax_number": "402-999-4786",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "BOBBI",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "PEER SPECIALIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-12-05",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "NE",
            "license": "52521",
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NE",
            "license": "CPSS-305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Athar Saifaidin Fadul
• Nada Abdellatif Fadul, M.D.
• Jaden Faeller
• Adam Fagan
• Arthur Fagan
• Donald. Fagan, R.P.
• Susan Katherine Fager, PHD, CCC-SLP
• James Patrick Fagerland, MD
• John Fagerland
• Walter Joseph Fahey, DDS

• Peer Specialist in Omaha, NE
• Providers in Omaha, NE by specialty
• Peer Specialist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2024; 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.