MEDICARE: MS. TRACY R HAGAN AOCNP

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	71001230B	IN
2	363LA2100X	Acute Care Nurse Practitioner	3005183	KY

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00082583	OTHER		RR MEDICARE
4	P01079960	OTHER	KY	RR MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1558324715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACY R HAGAN AOCNP

Provider Business Mailing Address
First Line	:	900 HOSPITAL DR
Second Line	:
City	:	MADISONVILLE
State	:	KY
Zip	:	42431-1644
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 HOSPITAL DR
Second Line	:
City	:	MADISONVILLE
State	:	KY
Zip	:	42431-1644
Country	:	US
Telephone Number	:	270-825-5800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	12/03/2020

900 HOSPITAL DR FL 5
MADISONVILLE, KY
42431-1644

Practice Phone: 270-825-5100
Practice Fax: