NPIMap

Individual provider Active NPI

Kimberly Hagedorn

  • Gerontology Nurse Practitioner
  • Cape Girardeau, MO
National Provider Identifier
1669832556
Registry record updated Mar 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
110790 Issued in MO
Practice address
1349 N Mount Auburn Rd
Cape Girardeau, MO 63701-1727
Phone
(573) 334-9564
Fax
(573) 334-1879
NPI assigned
Mar 4, 2016
Last updated
Mar 4, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 110790 MO Primary

Addresses

Primary practice location

1349 N Mount Auburn Rd
Cape Girardeau, MO 63701-1727

Mailing address

1349 N Mount Auburn Rd
Cape Girardeau, MO 63701-1727
Phone (573) 334-9564

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160329000790 MO Practitioner - Nurse Practitioner 1951608454 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Missouri Delta Medical CenterGroup PAC ID 1355252891, 134 clinicians

Practice addresses (Care Compare)

1126 N Main St
Sikeston, MO 63801-5046
Phone (573) 471-4312

789 S Mount Auburn Rd
Cape Girardeau, MO 63703-6387
Phone (573) 519-4830

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
110790MOMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Missouri Delta Medical Center CurrentSince May 1, 2024 Accepting new patients
Southeast Missouri Hospital Physicians, LLC CurrentSince Jun 1, 2017 Accepting new patients
Missouri Delta Medical Center CurrentSince May 1, 2024 Accepting new patients
Southeast Hospital Current Accepting new patients

Locations

789 S Mount Auburn Rd
Cape Girardeau, MO 63703
Phone (573) 519-4800

1701 Lacey St
Cpe Girardeau, MO 63701
Phone (573) 334-4822

1008 N Main St
Sikeston, MO 63801
Phone (573) 471-1600

1126 N Main St
Sikeston, MO 63801
Phone (573) 471-4312

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1457049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457049600000",
    "number": "1669832556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1349 N MOUNT AUBURN RD",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637011727",
            "telephone_number": "573-334-9564",
            "fax_number": "573-334-1879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1349 N MOUNT AUBURN RD",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637011727",
            "telephone_number": "573-334-9564",
            "fax_number": "573-334-1879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGEDORN",
        "first_name": "KIMBERLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-04",
        "last_updated": "2016-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MO",
            "license": "110790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Girardeau, MO

Sources for this page

Verify at the official NPI Registry.