Healthcare Provider Details

I. General information

NPI: 1033402482
Provider Name (Legal Business Name): HANA LYNN HAGGARD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE KENTUCKY CLINIC - GENERAL PEDIATRICS
LEXINGTON KY
40536
US

IV. Provider business mailing address

740 S LIMESTONE KENTUCKY CLINIC - GENERAL PEDIATRICS
LEXINGTON KY
40536
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5926
  • Fax:
Mailing address:
  • Phone: 859-323-5926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number390200000X
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR2653
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number03708
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: