Active NPI
Kathleen Mary Wagner, ARNP
- Obstetrics & Gynecology Nurse Practitioner
- Melbourne, FL
National Provider Identifier
1740397041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Nurse Practitioner
- License
- ARNP9333175
- Practice address
- 1223 Gateway Drive
Melbourne, FL 32901-2607 - Phone
- (321) 725-4500
- Fax
- (321) 722-1237
- NPI assigned
- Aug 23, 2006
- Last updated
- Sep 7, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | AP30000510 | WA | |
| Obstetrics & Gynecology Nurse Practitioner | 363LX0001X | ARNP9333175 | FL | Primary |
Addresses
Primary practice location
1223 Gateway Drive
Melbourne, FL 32901-2607
Mailing address
1223 Gateway Drive
Melbourne, FL 32901-2607
Phone (321) 725-4500
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9649823 | Medicaid | WA | |
| 807564400 | Medicaid | ID | |
| 0212946 | Other | WA | LABOR & INDUSTRIES |
Other names 1
- Kathleen Mary Bender
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP30000510 | WA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346976000000",
"number": "1740397041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1223 GATEWAY DRIVE",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329012607",
"telephone_number": "321-725-4500",
"fax_number": "321-722-1237"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1223 GATEWAY DRIVE",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329012607",
"telephone_number": "321-725-4500",
"fax_number": "321-722-1237"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "KATHLEEN",
"middle_name": "MARY",
"credential": "ARNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-23",
"last_updated": "2012-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WA",
"license": "AP30000510",
"primary": false
},
{
"code": "363LX0001X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Obstetrics & Gynecology",
"state": "FL",
"license": "ARNP9333175",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9649823",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "807564400",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & INDUSTRIES",
"identifier": "0212946",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KATHLEEN",
"last_name": "BENDER",
"middle_name": "MARY",
"credential": "ARNP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.