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General NPI Number Information
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NPI Number | 1477072460
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Entity Type | Individual
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Provider Name | KAMA RAE HAGEBUSCH APRN
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Gender | Female
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Dates
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Enumeration Date | 09/12/2017
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 401 S DEWEY AVE STE 108
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City | BARTLESVILLE
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State | OK
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Zip | 74003-3525
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Country | US
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Telephone | 580-747-5903
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Fax |
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Provider Business Mailing Address
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Address Line | 238 SE QUAIL RIDGE LOOP
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City | BARTLESVILLE
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State | OK
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Zip | 74006-2908
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Country | US
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Telephone | 580-747-5903
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 102797
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License Number State | OK
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