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General NPI Number Information
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NPI Number | 1801537642
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Entity Type | Individual
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Provider Name | AGEENA HASS
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Gender | Female
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 102780 US HIGHWAY 59
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City | SALLISAW
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State | OK
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Zip | 74955-4033
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Country | US
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Telephone | 918-571-6281
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Fax |
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Provider Business Mailing Address
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Address Line | 102780 US HIGHWAY 59
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City | FORT SMITH
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State | OK
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Zip | 72916-7019
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Country | US
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Telephone | 660-281-0018
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 8065
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License Number State | OK
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