Savannah Nycole Bagwell, LPN

Key facts

NPI

1629618640

Entity type

Individual (NPI type 1)

Primary specialty

Licensed Practical Nurse 164W00000X

License

67962 (OK)

Practice address

2307 Gordon Cooper Dr
Shawnee, OK 74801-9007

Phone

(405) 273-5236

NPI assigned

Jan 7, 2020

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 7, 2020.

{
    "created_epoch": "1578355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578355200000",
    "number": "1629618640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2307 GORDON COOPER DR",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748019007",
            "telephone_number": "405-273-5236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2307 GORDON COOPER DR",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748019007",
            "telephone_number": "405-273-5236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGWELL",
        "first_name": "SAVANNAH",
        "middle_name": "NYCOLE",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-07",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OK",
            "license": "67962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shawnee, OK

• Mark J Attanasi
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• Charles Ochieng' Awiti, OTR/L
• Kaitlyn Baca
• Latisha Lynn Bader, PH.D.
• Kenneth Bailes II, PHARMD.
• Kenneth Bailey Jr.
• Jennifer Elizabeth Baisden, D.D.S
• Peggy Baker, OTR
• Shivendra Bansal, M.D.

All providers in Shawnee, OK · Licensed Practical Nurse in Oklahoma