Mary Agnes Uttermohlen, MSN, FNP-BC, RN-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

569973 Issued in TX

Practice address

3100 Scofield Road #1179
Fort Sam Houston Primary Care Clinic
Fort Sam Houston, TX 78234

Phone

(210) 808-2470

Fax

(210) 808-3515

NPI assigned

Nov 9, 2005

Last updated

Nov 10, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Mary Agnes Stotts Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

State licenses

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

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320883200000",
    "number": "1699756494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 SCOFIELD ROAD #1179",
            "address_2": "FORT SAM HOUSTON PRIMARY CARE CLINIC",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "78234",
            "telephone_number": "210-808-2470",
            "fax_number": "210-808-3515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 SCOFIELD ROAD #1179",
            "address_2": "FORT SAM HOUSTON PRIMARY CARE CLINIC",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "78234",
            "telephone_number": "210-808-2470",
            "fax_number": "210-808-3515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UTTERMOHLEN",
        "first_name": "MARY",
        "middle_name": "AGNES",
        "name_prefix": "Ms.",
        "credential": "MSN, FNP-BC, RN-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-09",
        "last_updated": "2011-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "569973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "STOTTS",
            "middle_name": "AGNES",
            "prefix": "MRS.",
            "credential": "MSN-FNP-BC, RN-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Johnnie Ray Tyler III, PTA
• Katherine M Tyrell, LMSW
• Elizabeth Uecker, PA-C
• Claus Johan Ullstad, DDS, MS, MMS
• Jon Alan Umlauf, DPT
• Cheryl Vajdos, RN
• James Michael Valdez, LCSW
• Debra Valdivieso, CRNA
• Kody Vallejo, PHARMD
• Jan-Michael Van Gent, D.O.

• Family Nurse Practitioner in Fort Sam Houston, TX
• Providers in Fort Sam Houston, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2011; 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.

Verify at the official NPI Registry.