Individual ProviderKevin Patrick FaganNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1100 9th Ave, Seattle, WA 98101-2756(206) 223-6980(206) 515-5811PECOS EnrollmentBased on the most recent information from CMS, provider Kevin Patrick Fagan does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1124466495Provider TypeIndividualFull NameFagan, Kevin PatrickCredentialCRNAGenderMaleSole ProprietorNoEnumeration Date6/10/2013Last Updated7/23/2020Contact InformationPractice LocationPractice Address1100 9th Ave, Seattle, WA 98101-2756Phone(206) 223-6980FaxUnlisted FaxMailing LocationMailing Address1100 9th Ave, M4-Pfs, Seattle, WA 98101-2756Phone(206) 515-5811FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode367500000XPrimaryDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicenseAP61017573WashingtonCode367500000XDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicenseRN1020645District of Columbia