Healthcare Provider Details

I. General information

NPI: 1891329975
Provider Name (Legal Business Name): THOMAS HAGERMAN APRN-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E 2ND AVE
WILLIAMSON WV
25661-3602
US

IV. Provider business mailing address

PO BOX 734240
CHICAGO IL
60673-4240
US

V. Phone/Fax

Practice location:
  • Phone: 304-235-5780
  • Fax: 304-235-5799
Mailing address:
  • Phone: 815-744-8554
  • Fax: 630-495-1770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number104737
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number89489
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: