Provider Demographics
NPI:1023824570
Name:HAGAN, MEGAN RENEE (PNP-PC)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:RENEE
Last Name:HAGAN
Suffix:
Gender:F
Credentials:PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3947 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-3703
Mailing Address - Country:US
Mailing Address - Phone:402-660-6548
Mailing Address - Fax:
Practice Address - Street 1:3947 CLOVER LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-3703
Practice Address - Country:US
Practice Address - Phone:402-660-6548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202224489363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care