Healthcare Provider Details

I. General information

NPI: 1992386452
Provider Name (Legal Business Name): KARLEY NICOLE HAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 N COLLEGE AVE
FAYETTEVILLE AR
72703-1908
US

IV. Provider business mailing address

1125 N COLLEGE AVE
FAYETTEVILLE AR
72703-1908
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-0263
  • Fax: 479-521-8723
Mailing address:
  • Phone: 479-521-0263
  • Fax: 479-521-8723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: