Active NPI
Terri B Fagan, FNP
- Nurse Practitioner
- Medford, OR
National Provider Identifier
1568591998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 9500954N1
- Practice address
- 2825 E Barnett Rd
Medford, OR 97504-8332 - Phone
- (541) 789-7000
- NPI assigned
- Mar 2, 2007
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 9500954N1 | OR | Primary |
Addresses
Primary practice location
2825 E Barnett Rd
Medford, OR 97504-8332
Mailing address
100 E Main St
Suite C
Medford, OR 97501-6041
Phone (541) 789-7000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 078071 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9500954N1 | OR | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1568591998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 E MAIN ST",
"address_2": "SUITE C",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975016041",
"telephone_number": "541-789-7000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2825 E BARNETT RD",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975048332",
"telephone_number": "541-789-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGAN",
"first_name": "TERRI",
"middle_name": "B",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "OR",
"license": "9500954N1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "078071",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.