Kathy Wagle, APRN, CNS is a medicare enrolled "Clinical Nurse Specialist - Psychiatric/mental Health, Child & Adolescent" in St Louis Park, Minnesota. Her current practice location is
3800 Park Nicollet Blvd, St Louis Park, Minnesota. You can reach out to her office (for appointments etc.) via phone at
(952) 993-3307.
Kathy Wagle is licensed to practice in Minnesota (license number CNS 0187) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1912983727.
Provider's Profile
| Full Name | Kathy Wagle |
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| Gender | Female |
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| Speciality | Clinical Nurse Specialist - Psychiatric/mental Health, Child & Adolescent |
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| Location | 3800 Park Nicollet Blvd, St Louis Park, Minnesota |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1912983727
- Provider Enumeration Date: 12/22/2005
- Last Update Date: 03/11/2016
Medicare PECOS Information:
- PECOS PAC ID: 4486849569
- Enrollment ID: I20101115000930
Medical Identifiers
Medical identifiers for Kathy Wagle such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1912983727 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 163WP0809X | Registered Nurse - Psychiatric/mental Health, Adult | R0782195 (Minnesota) | Secondary |
| 364SP0807X | Clinical Nurse Specialist - Psychiatric/mental Health, Child & Adolescent | CNS 0187 (Minnesota) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kathy Wagle allows following entities to bill medicare on her behalf.
| Entity Name | Park Nicollet Clinic |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1780621904
PECOS PAC ID: 7911819438
Enrollment ID: O20031104000046 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kathy Wagle is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Kathy Wagle, APRN, CNS
8170 33rd Ave S, Po Box 1309 Mail Stop 21110q,
Minneapolis, MN 55425-4516
Ph: () - | Kathy Wagle, APRN, CNS
3800 Park Nicollet Blvd,
St Louis Park, MN 55416-2527
Ph: (952) 993-3307 |
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