Provider Demographics
NPI:1316496862
Name:LAGESSE, KATHLEEN WILKIN (AGNP-C)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:WILKIN
Last Name:LAGESSE
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:980-302-7800
Mailing Address - Fax:980-302-7805
Practice Address - Street 1:134 MEDICAL PARK RD STE 200
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8527
Practice Address - Country:US
Practice Address - Phone:980-302-7800
Practice Address - Fax:980-302-7805
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5008961363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health