=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245179001
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH HEGARTY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2026
-----------------------------------------------------
Last Update Date | 03/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 KENNY RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43210-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-202-4927
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5681 YANKEETOWN PIKE
-----------------------------------------------------
City | CIRCLEVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43113-9698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-202-4927
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 360554
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------