Healthcare Provider Details

I. General information

NPI: 1629367636
Provider Name (Legal Business Name): TARA NIKOLE HAGER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA NIKOLE TOBIN

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FAIRGROUNDS RD
HARDINSBURG KY
40143-2585
US

IV. Provider business mailing address

107 CRANES ROOST CT
ELIZABETHTOWN KY
42701-3650
US

V. Phone/Fax

Practice location:
  • Phone: 270-756-5816
  • Fax: 270-756-5815
Mailing address:
  • Phone: 270-765-2605
  • Fax: 270-234-8572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3006827
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: