Healthcare Provider Details

I. General information

NPI: 1447221890
Provider Name (Legal Business Name): JENNIFER K HAGENSCHNEIDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JENNIFER KAY LEVENGOOD

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 KY 59
VANCEBURG KY
41179-7647
US

IV. Provider business mailing address

PO BOX 550
VANCEBURG KY
41179-0550
US

V. Phone/Fax

Practice location:
  • Phone: 606-796-3029
  • Fax:
Mailing address:
  • Phone: 606-796-3029
  • Fax: 844-474-7624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.085909
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number32715
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number39945
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: