Provider Demographics
NPI:1568048890
Name:HAGAN, STEVE D (NP)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:D
Last Name:HAGAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 OLD FLORENCE PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:LEOMA
Mailing Address - State:TN
Mailing Address - Zip Code:38468-5363
Mailing Address - Country:US
Mailing Address - Phone:931-244-0105
Mailing Address - Fax:
Practice Address - Street 1:726 N LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-2865
Practice Address - Country:US
Practice Address - Phone:931-766-7056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29059363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner