Provider Demographics
NPI:1023478310
Name:HASS, CALLA M (APRN)
Entity type:Individual
Prefix:
First Name:CALLA
Middle Name:M
Last Name:HASS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CALLA
Other - Middle Name:M
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1325 TRIPLETT ST
Mailing Address - Street 2:# A
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3163
Mailing Address - Country:US
Mailing Address - Phone:270-686-8500
Mailing Address - Fax:270-685-5467
Practice Address - Street 1:1325 TRIPLETT ST
Practice Address - Street 2:# A
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3163
Practice Address - Country:US
Practice Address - Phone:270-686-8500
Practice Address - Fax:270-685-5467
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100393890Medicaid
KY7100393890Medicaid