Individual
KYLE HAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA0C
Contact information
Practice address
1400 S GERMANTOWN RD, GERMANTOWN, TN 38138-2205
(901) 759-3100
Mailing address
1400 S GERMANTOWN RD, GERMANTOWN, TN 38138-2205
(901) 759-5443
(901) 759-3196
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08402771
—
MS
05
—
Q061378
—
TN
Enumeration date
09/15/2017
Last updated
10/05/2022
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