Provider Demographics
NPI:1477072460
Name:HAGEBUSCH, KAMA RAE (APRN)
Entity Type:Individual
Prefix:
First Name:KAMA
Middle Name:RAE
Last Name:HAGEBUSCH
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 1:1239 GRANDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-5006
Mailing Address - Country:US
Mailing Address - Phone:580-747-5903
Mailing Address - Fax:
Practice Address - Street 1:1239 GRANDVIEW RD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-5006
Practice Address - Country:US
Practice Address - Phone:580-747-5903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK102797363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily