Healthcare Provider Details

I. General information

NPI: 1700760337
Provider Name (Legal Business Name): HAYDEN SKEET LEGGETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 HERITAGE TRACE PKWY
FORT WORTH TX
76177-7505
US

IV. Provider business mailing address

3451 HERITAGE TRACE PKWY
FORT WORTH TX
76177-7505
US

V. Phone/Fax

Practice location:
  • Phone: 817-232-8632
  • Fax: 800-532-1769
Mailing address:
  • Phone: 817-232-8632
  • Fax: 800-532-1769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number292993
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: