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General NPI Number Information
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NPI Number | 1689178006
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Entity Type | Individual
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Provider Name | HEATHER LYNN HAGAN MSN, NP-C
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Gender | Female
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 01/30/2020
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Provider Practice Location Address
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Address Line | 1015 W MEDICAL CENTER BLVD STE 1100
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City | WEBSTER
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State | TX
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Zip | 77598-4055
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Country | US
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Telephone | 281-316-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 13703 CORKEN WAY CT
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City | HOUSTON
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State | TX
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Zip | 77034-2365
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Country | US
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Telephone | 409-781-0146
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP136747
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 839574
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License Number State | TX
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