Healthcare Provider Details

I. General information

NPI: 1356169783
Provider Name (Legal Business Name): KRISTIN HAGOPIAN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 E UNION AVE
LITCHFIELD IL
62056-1768
US

IV. Provider business mailing address

1365 E UNION AVE
LITCHFIELD IL
62056-1768
US

V. Phone/Fax

Practice location:
  • Phone: 217-969-1365
  • Fax: 833-471-2122
Mailing address:
  • Phone: 217-969-1365
  • Fax: 833-471-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209030616
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: