Healthcare Provider Details

I. General information

NPI: 1487628566
Provider Name (Legal Business Name): KELLY L HARGETT PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/19/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 LAKEVIEW AVENUE
DRACUT MA
01826-3414
US

IV. Provider business mailing address

18 SINGLEFOOT RD
CHELMSFORD MA
01824-1926
US

V. Phone/Fax

Practice location:
  • Phone: 978-545-1442
  • Fax: 978-545-1552
Mailing address:
  • Phone: 978-545-1442
  • Fax: 978-545-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number258985
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number258985
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: