Healthcare Provider Details

I. General information

NPI: 1811564289
Provider Name (Legal Business Name): CLAIRE HAGAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2021
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 OLD LEBANON RD
CAMPBELLSVILLE KY
42718-3319
US

IV. Provider business mailing address

1400 MCELROY PIKE
LEBANON KY
40033-9321
US

V. Phone/Fax

Practice location:
  • Phone: 270-789-2445
  • Fax: 270-465-4669
Mailing address:
  • Phone: 270-699-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3016194
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: