Brenda Kay Hagemann, MSN, APRN, BC FNP
Individual provider Active NPI Nurse Practitioner · Cottonwood, ID
NPI 1992708671 · NPPES record last updated Sep 27, 2019
Key facts
- NPI
- 1992708671
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- NP300A (ID)
- Practice address
- 701 Lewiston St
Cottonwood, ID 83522-9750 - Phone
- (208) 962-3267
- Fax
- (208) 962-2313
- NPI assigned
- May 24, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science - Nursing, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP300A | ID | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clearwater Valley Hospital & Clinics Inc. | Past | Accepting new patients | |
| St. Mary'S Hospital Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | NP300A | ID | Yes |
Addresses
Primary practice location
701 Lewiston St
Cottonwood, ID 83522-9750
Mailing address
420 N. 2ND Ave
Sandpoint, ID 83864
Phone (208) 263-0450
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 804211800 | Medicaid | ID |
Other names
- Ms. Brenda Kay Hewlett
Other providers in Cottonwood, ID
- Cottonwood Physical Therapy, PLLC
- Cottonwood Shelter Home Inc
- Margaret A Gehring
- Bryan Leon Gimmeson
- Holly Graham
- Nicholas B Henrie
- Ronald Lee Jeanblanc II
- Tema Lynn Jessup
- Andrew F Jones
- Justin Leroy Jones
All providers in Cottonwood, ID · Nurse Practitioner in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.