Provider Demographics
NPI:1033622022
Name:HAGY, CHELSEY (RN)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:
Last Name:HAGY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:MEADOWVIEW
Mailing Address - State:VA
Mailing Address - Zip Code:24361-0128
Mailing Address - Country:US
Mailing Address - Phone:276-623-3855
Mailing Address - Fax:276-698-2912
Practice Address - Street 1:29435 HAWTHORNE DR
Practice Address - Street 2:
Practice Address - City:MEADOWVIEW
Practice Address - State:VA
Practice Address - Zip Code:24361-2937
Practice Address - Country:US
Practice Address - Phone:276-628-3855
Practice Address - Fax:276-698-2912
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001245061163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0175559878Medicaid