Healthcare Provider Details

I. General information

NPI: 1598429540
Provider Name (Legal Business Name): JOELLE B HAGAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOELLE BOARMAN

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S WATER ST
LOUISA KY
41230-1347
US

IV. Provider business mailing address

PO BOX 726
LOUISA KY
41230-0726
US

V. Phone/Fax

Practice location:
  • Phone: 606-649-2211
  • Fax: 606-638-1399
Mailing address:
  • Phone: 606-638-0938
  • Fax: 859-813-5394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3016803
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3016803
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: