Healthcare Provider Details

I. General information

NPI: 1992696041
Provider Name (Legal Business Name): TRAVIS TYLER HARGETT APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WINDSOR PATH STE 5
GEORGETOWN KY
40324-9819
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7725
US

V. Phone/Fax

Practice location:
  • Phone: 888-585-8434
  • Fax: 216-456-8128
Mailing address:
  • Phone: 888-585-8434
  • Fax: 216-456-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4041792
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: