MEDICARE: MRS. MEGAN RENEE HAGAN PNP-PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	202224489	TX
2	363LP0200X	Pediatric Nurse Practitioner	1110278	TX

General Provider Information

NPI Number	:	1023824570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN RENEE HAGAN PNP-PC

Provider Business Mailing Address
First Line	:	3947 CLOVER LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-3703
Country	:	US
Telephone Number	:	402-660-6548
Fax Number	:

Provider Business Practice Location Address
First Line	:	3947 CLOVER LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-3703
Country	:	US
Telephone Number	:	402-660-6548
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2024
Last Update Date	:	10/24/2025

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