Mary Kyndra Nicole Hagan

Primary specialty

Developmental TherapistTaxonomy code 222Q00000X

Practice address

1912 Terrance Pointe
Owensboro, KY 42303

Phone

(727) 340-2772

NPI assigned

Jun 3, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Superior Speech Therapy Services, LLC

  • Speech-Language Pathologist
  • Dover, FL
  • NPI 1437744513
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707696000000",
    "number": "1336888676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1912 TERRANCE POINTE",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "42303",
            "telephone_number": "727-340-2772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1912 TERRANCE POINTE",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "42303",
            "telephone_number": "727-340-2772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGAN",
        "first_name": "MARY KYNDRA",
        "middle_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-03",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "REST",
            "endpointTypeDescription": "RESTful URL",
            "endpoint": "RESTfulURL",
            "affiliation": "N",
            "endpointDescription": "RESTful URL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "15614 Dr Mlk Jr. Blvd",
            "address_2": "Suite A",
            "city": "Dover",
            "state": "FL",
            "country_code": "US",
            "postal_code": "33527",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nityanand Gupta, MD
• Hadley Jagoe Counseling
• Laura E Haga, APRN
• Brooklyn Lynn Hagan, BS
• Linda Browning Hagan, OTR
• James Roger Hagerman, PA
• Leslee Poole Haile, APRN
• Emily Haire, DPT
• Troy Lee Haleman, MD
• James Wayne Hall, PHARMACIST

• Developmental Therapist in Owensboro, KY
• Providers in Owensboro, KY by specialty
• Developmental Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.