Provider Demographics
NPI:1669699476
Name:HAGEN, LYNDA JEANETTE (PMHNP, FNP)
Entity type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:JEANETTE
Last Name:HAGEN
Suffix:
Gender:F
Credentials:PMHNP, FNP
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:JEANETTE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:243 KING RANCH CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-9289
Mailing Address - Country:US
Mailing Address - Phone:817-448-8243
Mailing Address - Fax:
Practice Address - Street 1:2700 TIBBETS DR
Practice Address - Street 2:SUITE 500
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-5928
Practice Address - Country:US
Practice Address - Phone:817-545-9100
Practice Address - Fax:817-545-9143
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX449126363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health