Provider Demographics
NPI:1811564289
Name:HAGAN, CLAIRE (APRN)
Entity Type:Individual
Prefix:MS
First Name:CLAIRE
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 1:1400 MCELROY PIKE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-9321
Mailing Address - Country:US
Mailing Address - Phone:270-699-0703
Mailing Address - Fax:
Practice Address - Street 1:6420 DUTCHMANS PKWY STE 190
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3313
Practice Address - Country:US
Practice Address - Phone:502-588-7660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-05
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100779490Medicaid