Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 11-03982 | KS |
NPI | 1457589731 |
---|---|
Provider Name | Kelli L Hagen |
First Address | Lenexa, KS 66214-1505 |
Second Address | Lenexa, KS 66214-1505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2009 |
Last Update Date | 26/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
42826014 | BLUECROSS BLUE SHEILD KC (01) | |
P00975021 | MEDICARE RAILROAD (01) |