Healthcare Provider Details

I. General information

NPI: 1457790628
Provider Name (Legal Business Name): KATHLEEN MARIE CAGLE RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2823 FRESNO ST
FRESNO CA
93721-1324
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-0002
US

V. Phone/Fax

Practice location:
  • Phone: 559-499-6439
  • Fax: 559-499-6441
Mailing address:
  • Phone: 216-444-7793
  • Fax: 216-636-3179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN541602
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number276144
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP23256
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0035903
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: