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NPI Code Detail

MEDICARE: KAMA RAE HAGEBUSCH APRN

MEDICARE: KAMA RAE HAGEBUSCH APRN
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
1363LF0000XFamily Nurse Practitioner102797OK

General Provider Information

NPI Number : 1477072460
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAMA RAE HAGEBUSCH APRN
Provider Business Mailing Address
First Line : 238 SE QUAIL RIDGE LOOP
Second Line :
City : BARTLESVILLE
State : OK
Zip : 74006-2908
Country : US
Telephone Number : 580-747-5903
Fax Number :
Provider Business Practice Location Address
First Line : 401 S DEWEY AVE STE 108
Second Line :
City : BARTLESVILLE
State : OK
Zip : 74003-3525
Country : US
Telephone Number : 580-747-5903
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2017
Last Update Date : 03/03/2026

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