Provider Demographics
NPI:1487628566
Name:HARGETT, KELLY L (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:HARGETT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SINGLEFOOT RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1926
Mailing Address - Country:US
Mailing Address - Phone:978-545-1442
Mailing Address - Fax:978-545-1552
Practice Address - Street 1:1385 LAKEVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-3414
Practice Address - Country:US
Practice Address - Phone:978-545-1442
Practice Address - Fax:978-545-1552
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA258985364S00000X, 364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0703648Medicaid
MAAA17334OtherHARVARD PILGRIM
MANP9680OtherBLUE CROSS
MA0703648Medicaid
MAP37302Medicare UPIN