Provider Demographics
NPI:1124045711
Name:JAGGERS, KATHY A (WHNP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:A
Last Name:JAGGERS
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-921-2701
Practice Address - Street 1:1250 8TH AVENUE
Practice Address - Street 2:SUITE 440
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4144
Practice Address - Country:US
Practice Address - Phone:817-923-5558
Practice Address - Fax:817-921-2701
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX612285363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
500030127OtherRAILROAD MEDICARE
TX141137302Medicaid
TX141137304Medicaid