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Contact Information

JACKLYN HAGG, AGACNP
3100 CHANNING WAY
IDAHO FALLS, ID83404-7533
 Phone: 208-529-6111
 Fax: 208-529-7021
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Practitioner

363L00000X 50 Nurse Practitioner
 

Acute Care

363LA2100X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for JACKLYN HAGG · (Female)

NPI Number 1861928111
Status Active
Credentials AGACNP
Entity Individual
Enumeration date 05/05/2017
Last updated 06/17/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • ID License # 66593
  • WA License # AP 60730619
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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