MEDICARE: MS. KATHY K HAGER A.F.N.P.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	2350P	KY

Other Identifiers

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

General Provider Information

NPI Number	:	1790735637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHY K HAGER A.F.N.P.

Provider Business Mailing Address
First Line	:	130 STONECREST RD
Second Line	:	SUITE 106
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-8126
Country	:	US
Telephone Number	:	502-647-1000
Fax Number	:	502-647-1006

Provider Business Practice Location Address
First Line	:	130 STONECREST RD
Second Line	:	SUITE 106
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-8126
Country	:	US
Telephone Number	:	502-647-1000
Fax Number	:	502-647-1006

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/09/2007

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