Provider Demographics
NPI:1194209379
Name:KAGAN, JENNIFER PROCTER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PROCTER
Last Name:KAGAN
Suffix:
Gender:F
Credentials:
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 4337
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-4337
Mailing Address - Country:US
Mailing Address - Phone:970-668-4040
Mailing Address - Fax:970-668-6699
Practice Address - Street 1:360 PEAK ONE DRIVE
Practice Address - Street 2:SUITE #100
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-4040
Practice Address - Fax:970-668-6699
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994111363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily