Provider Demographics
NPI:1083446595
Name:HAGELGANTZ, ERIKA (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:
Last Name:HAGELGANTZ
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S OLD MANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:TX
Mailing Address - Zip Code:76059-2016
Mailing Address - Country:US
Mailing Address - Phone:785-409-7641
Mailing Address - Fax:
Practice Address - Street 1:214 N CADDO ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76031-4904
Practice Address - Country:US
Practice Address - Phone:785-409-7641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1137317363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX331586838Medicaid