Provider Demographics
NPI:1629095567
Name:ZAGARIS, KAY (NP)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:ZAGARIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 SCENIC DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-6131
Mailing Address - Country:US
Mailing Address - Phone:209-558-7000
Mailing Address - Fax:
Practice Address - Street 1:1209 WOODROW AVE
Practice Address - Street 2:SUITE B-10
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1288
Practice Address - Country:US
Practice Address - Phone:209-558-5312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP12514363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN283412OtherMEDICAL PROVIDER NUMBER