Provider Demographics
NPI:1043805088
Name:GAGEN, JESSICA CAITLIN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:CAITLIN
Last Name:GAGEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 SAND RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-4493
Mailing Address - Country:US
Mailing Address - Phone:419-806-7812
Mailing Address - Fax:
Practice Address - Street 1:455 W 4TH ST STE 100
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-1864
Practice Address - Country:US
Practice Address - Phone:419-436-6680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0028343363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner