DR. KELLENE VOKATY EAGEN (NPI# 1639407174) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639407174 |
| Entity Type | Individual |
| Full Name | DR. KELLENE VOKATY EAGEN |
| Credential | MD |
| Practice Address |
1102 S Park St Madison WI 53715-1708 |
| Mailing Address |
7974 Uw Health Ct Middleton WI 53562-5531 |
| Practice Telephone | 6082633111 |
| Mailing Fax Number | 4156746378 |
| Enumeration Date | 2009-11-20 |
| Last Update Date | 2020-03-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | A112630 | CA | Allopathic & Osteopathic Physicians |
| Y | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
72455-20 | WI | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 995 Portrero Ave # 83, San Francisco, CA 941102859 | 4152065252 | 4152068387 |
| 230 Golden Gate Ave, San Francisco, CA 941023706 | 4153557400 | 4156746378 |
| Street Address |
1102 S PARK ST |
| City | MADISON |
| State | WI |
| Zip Code | 53715-1708 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609878453 | Cheryl Roets | Psychologist | 1102 S Park St, Madison, WI 53715-1708 | 2005-08-11 |
| 1679102537 | Caroline Hensley | Student in an Organized Health Care Education/Training Program | 1102 S Park St, Madison, WI 53715-1708 | 2020-04-03 |
| 1720617624 | Justin Temple | Student in an Organized Health Care Education/Training Program | 1102 S Park St, Madison, WI 53715-1708 | 2020-04-03 |
| 1770112658 | Ana Pearson | Student in an Organized Health Care Education/Training Program | 1102 S Park St, Madison, WI 53715-1708 | 2020-04-03 |
| 1669001616 | Estefan Beltran | Student in an Organized Health Care Education/Training Program | 1102 S Park St, Madison, WI 53715-1708 | 2020-04-02 |
| 1003378886 | Melanie A Hellrood | Student in an Organized Health Care Education/Training Program | 1102 S Park St, Madison, WI 53715-1708 | 2019-04-02 |
| 1831651603 | Anne M Drolet | Student in an Organized Health Care Education/Training Program | 1102 S Park St, Madison, WI 53715-1708 | 2019-04-02 |
| 1568924363 | Morgan S White | Student in an Organized Health Care Education/Training Program | 1102 S Park St, Madison, WI 53715-1708 | 2019-04-02 |
| 1619439403 | Jeremiah J Shaw | Student in an Organized Health Care Education/Training Program | 1102 S Park St, Madison, WI 53715-1708 | 2019-04-02 |
| 1912486531 | Rachael Marie Finn | Physician Assistant | 1102 S Park St, Madison, WI 53715 | 2018-08-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851807697 | Kristi M Batchelor | Nurse Practitioner | 20 S Park St Fl 4, Madison, WI 53715 | 2017-12-15 |
| 1578927026 | Petra A Kelsey | Family Medicine | 1107 Emerald St, Madison, WI 53715 | 2016-04-11 |
| 1467889238 | Group Health Cooperative of South Central Wi | Durable Medical Equipment & Medical Supplies | 740 Regent Street, Suite 106, Madison, WI 53715 | 2013-10-10 |
| 1275888760 | Sandra Beth Miller | Physician Assistant | 700 S. Park, Suite A 404, Madison, WI 53715 | 2012-07-20 |
| 1134418486 | Matthew Lochen | Emergency Medicine | 700 S. Park Street, Department of Emergency Medicine, Madison, WI 53715 | 2011-04-06 |
| 1225275720 | Eileen J Breitweiser | Social Worker | 202 South Parkt Street, Madison, WI 53715 | 2009-01-21 |
| 1225293137 | Kenneth H. Yuska, Md, Sc | Orthopaedic Surgery | 4726 East Towne Blvd., 110, Madison, WI 53715 | 2008-07-21 |
| 1063689727 | Rachel I Kornik | Dermatology | Uw Health Dept of Dermatology 1 S. Park St, Administrative Office 7th Floor, Madison, WI 53715 | 2008-05-13 |
| 1144434911 | Rebecca Sue Frye | Pharmacist | 1 South Park Street, Suite 101 Pharmacy, Madison, WI 53715 | 2007-05-10 |
| 1376755496 | Eileen C. Scrivner | Social Worker | 1008 Fish Hatchery Road, Madison, WI 53715 | 2007-05-03 |
| Find all providers in zip 53715 | ||||
| Taxonomy Code | 2084A0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Medicine |
| A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |
| Notes: Source: American Osteopathic Board of Neurology and Psychiatry, 2007 [1/1/2008: definition added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578709713 | Holloway Psychiatric Services, Inc. | Psychiatry & Neurology | 742d Magnolia St, Madison, MS 39110-8903 | 2008-12-17 |
| 1548206360 | William Carlin Bucknam | Psychiatry & Neurology | 1018 Gammon Ln, Madison, WI 53719-2256 | 2006-06-21 |
| 1487709200 | Matthew A Felgus | Psychiatry & Neurology | 6333 Odana Rd, Suite 3, Madison, WI 53719-1170 | 2007-01-24 |
| 1417929209 | Michael M Miller | Psychiatry & Neurology | 202 S Park St, Madison, WI 53715-1507 | 2006-02-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538352323 | Stephen B Hull | Psychiatry & Neurology | 8315 Steeple Hill Dr, Larsen, WI 54947-9538 | 2007-08-24 |
| 1124148747 | Ivars Gailans | Psychiatry & Neurology | 180 N Milwaukee St, Milwaukee, WI 53202-6013 | 2007-03-29 |
| 1780730515 | Sheila W. Sorkin, M.d. LLC | Psychiatry & Neurology | 11430 W Bluemound Rd, Suite 109, Wauwatosa, WI 53226-4050 | 2007-01-26 |
| 1568577534 | Sheila W Sorkin | Psychiatry & Neurology | 11430 W. Bluemound Road Suite 109, Wauwatosa, WI 53226 | 2006-08-20 |
| 1205873882 | Paul W Harris | Psychiatry & Neurology | 3267 S 16tj Street, Room 200, Milwaukee, WI 53215-4500 | 2006-06-01 |
| 1417461401 | Jennifer Lynn Brubaker | Psychiatry & Neurology | 2842 S Business Dr, Sheboygan, WI 53081-6518 | 2017-11-29 |
| 1417322868 | Prevail Psychiatry LLC | Psychiatry & Neurology | 2222 N Mayfair Rd, Wauwatosa, WI 53226-2208 | 2015-12-10 |
| 1184868598 | Richard K Wagner | Psychiatry & Neurology | 903 Mineral Point Ave, Janesville, WI 53548-2970 | 2009-04-29 |
| 1740469873 | Raymond W. Moy Md Sc | Psychiatry & Neurology | 6917 W Oklahoma Ave, Milwaukee, WI 53219-2973 | 2007-10-25 |
| 1811055940 | Frederic B Will | Psychiatry & Neurology | 4810 Northwestern Ave, Racine, WI 53406-1504 | 2006-12-04 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.