Provider Demographics
NPI:1578995171
Name:HAGAN, MICHELLE HOPE (CRNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:HOPE
Last Name:HAGAN
Suffix:
Gender:F
Credentials:CRNP
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 401
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35652-0401
Mailing Address - Country:US
Mailing Address - Phone:256-247-0093
Mailing Address - Fax:256-247-5289
Practice Address - Street 1:16053 HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35652-8141
Practice Address - Country:US
Practice Address - Phone:256-247-0093
Practice Address - Fax:256-247-5289
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN137509163WR0006X
AL1-099297363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163W00000XNursing Service ProvidersRegistered Nurse