Provider Demographics
NPI:1770980377
Name:HAGAN, JAMEY (FNP-C)
Entity type:Individual
Prefix:
First Name:JAMEY
Middle Name:
Last Name:HAGAN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 BROOKMEADE DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4085
Mailing Address - Country:US
Mailing Address - Phone:931-840-8525
Mailing Address - Fax:931-840-8535
Practice Address - Street 1:2150 BROOKMEADE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4085
Practice Address - Country:US
Practice Address - Phone:931-840-8525
Practice Address - Fax:931-840-8535
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19429363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily