Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 3016004 | KY |
NPI | 1003404534 |
---|---|
Provider Name | Miranda Hagan |
First Address | Hodgenville, KY 42748-9780 |
Second Address | Hodgenville, KY 42748-9780 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2021 |
Last Update Date | 12/10/2021 |