Provider Demographics
NPI:1881003218
Name:HAGAN, KARA (PA-C)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:HAGAN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 NW 136TH AVE BLDG H
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:865-560-7110
Practice Address - Street 1:752 E CENTER AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2591
Practice Address - Country:US
Practice Address - Phone:704-800-0570
Practice Address - Fax:704-660-1752
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-12009363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant