Provider Demographics
NPI:1003404534
Name:HAGAN, MIRANDA (APRN)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:HAGAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 E NEW CIRCLE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-4138
Mailing Address - Country:US
Mailing Address - Phone:859-303-5918
Mailing Address - Fax:859-303-5918
Practice Address - Street 1:1018 E NEW CIRCLE RD STE 205
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4138
Practice Address - Country:US
Practice Address - Phone:859-303-5918
Practice Address - Fax:859-303-5918
Is Sole Proprietor?:No
Enumeration Date:2021-01-10
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016004363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner