Provider Demographics
NPI:1992485775
Name:HADLEY, KERRIGAN PAIGE
Entity type:Individual
Prefix:
First Name:KERRIGAN
Middle Name:PAIGE
Last Name:HADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 ULTIMA THULE RD
Mailing Address - Street 2:
Mailing Address - City:EAGLETOWN
Mailing Address - State:OK
Mailing Address - Zip Code:74734-3412
Mailing Address - Country:US
Mailing Address - Phone:580-916-2074
Mailing Address - Fax:
Practice Address - Street 1:1212 E KIRK ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-3607
Practice Address - Country:US
Practice Address - Phone:580-326-5279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator