Agile Private Enterprise LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

AGILE PRIVATE ENTERPRISE LLC

Practice address

1725 Blue Stream Dr
Desoto, TX 75115-3962

Phone

(469) 834-7478

NPI assigned

Sep 17, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Tawanna Sargent, PH.D.

Title

Ceo/Owner

Phone

(469) 834-7478

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1726531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726531200000",
    "number": "1831926518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1725 BLUE STREAM DR",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751153962",
            "telephone_number": "469-834-7478",
            "fax_number": "469-942-7662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1725 BLUE STREAM DR",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751153962",
            "telephone_number": "469-834-7478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGILE PRIVATE ENTERPRISE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-17",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A",
        "authorized_official_last_name": "SARGENT",
        "authorized_official_first_name": "TAWANNA",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "469-834-7478",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.