Provider Demographics
NPI:1841642535
Name:HAGEN, SHANE (DNP, AGACNP, FNP)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:HAGEN
Suffix:
Gender:M
Credentials:DNP, AGACNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7709 W 151ST ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2219
Mailing Address - Country:US
Mailing Address - Phone:816-447-6138
Mailing Address - Fax:
Practice Address - Street 1:7709 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2219
Practice Address - Country:US
Practice Address - Phone:916-600-5808
Practice Address - Fax:913-600-5838
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016000962363LA2100X
KS53-81393-121363L00000X
MO2019001965363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily