Provider Demographics
NPI:1801874839
Name:HAGAN, EMILIE A (ARNP, CDE)
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:A
Last Name:HAGAN
Suffix:
Gender:F
Credentials:ARNP, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7329 N WOODLAWN ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67147-8560
Mailing Address - Country:US
Mailing Address - Phone:316-219-3571
Mailing Address - Fax:316-219-3573
Practice Address - Street 1:1431 BLUFFVIEW ST
Practice Address - Street 2:STE. 102
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3039
Practice Address - Country:US
Practice Address - Phone:316-219-3571
Practice Address - Fax:316-219-3573
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74122364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS9383OtherPREFERRED HEALTH CARE ID
KS436680OtherFIRST GUARD - MEDICAID
KS207996OtherHEALTH PARTNERS OF KANSAS
KS3413735OtherCIGNA INS ID
KSS93420Medicare UPIN
KS436680OtherFIRST GUARD - MEDICAID