Individual
MS. TRACY R HAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AOCNP
Contact information
Practice address
900 HOSPITAL DR, MADISONVILLE, KY 42431-1644
(270) 825-5800
Mailing address
900 HOSPITAL DR, MADISONVILLE, KY 42431-1644
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
3005183
KY
363LA2100X
Acute Care Nurse Practitioner
71001230B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200445130
—
IN
05
—
78007838
—
KY
01
—
P00082583
RR MEDICARE
—
01
—
P01079960
RR MEDICARE
KY
Enumeration date
04/10/2006
Last updated
12/03/2020
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