KENDALL FAGAN DO
NPI 1053006049
Student in an Organized Health Care Education/Training Program in Tulsa, OK

Q: What is Kendall Fagan's NPI number?

The NPI number for Kendall Fagan is 1053006049. It was assigned to this individual provider in the NPPES registry on April 6, 2023.

Q: What is Kendall Fagan's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Kendall Fagan was last updated on July 28, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 06, 2023PECOS EnrolledAccepts Medicare Assignment

4502 E 41ST ST, TULSA, OK 74135(530) 526-1596 Get Directions Write a Review

NPPES record last updated: July 28, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 28, 2024, Apr 6, 2023 (2 updates tracked since 2023).

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About Kendall Fagan Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENDALL FAGAN DO (NPI 1053006049) is an individual student in an organized health care education/training program in Tulsa, Oklahoma and active in the NPI registry since April 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1053006049

Entity TypeIndividualFemale

Primary Taxonomy390200000X

Provider Legal NameKENDALL FAGANCredential: DO

Location Address4502 E 41ST STTulsa, OK 74135-2536

Mailing Address980 12th StIdaho Falls, ID 83404-5051

Phone(530) 526-1596

Sole ProprietorNo

Medical School CMSOtherGraduated 2024

Enumeration DateApril 6, 2023

Last NPPES UpdateJuly 28, 20242 updates tracked since enumeration

NPPES CertifiedJuly 28, 2024

✔ NPI 1053006049 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

4502 E 41ST ST, Tulsa, OK 74135

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kendall Fagan Do is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8224506209

PECOS Enrollment IDI20260508000290

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. MICHAEL DANIEL FIGUEIREDO MD

Emergency Medicine