Provider Demographics
NPI:1386715571
Name:HAGAN & ASSOCIATES, LLC
Entity type:Organization
Organization Name:HAGAN & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:316-219-3571
Mailing Address - Street 1:7329 N WOODLAWN ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67147-8560
Mailing Address - Country:US
Mailing Address - Phone:316-219-3571
Mailing Address - Fax:
Practice Address - Street 1:1431 BLUFFVIEW ST
Practice Address - Street 2:SUITE 108
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3039
Practice Address - Country:US
Practice Address - Phone:316-219-3571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-11
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110580OtherBC BS
KS110580Medicare ID - Type Unspecified