Provider Demographics
NPI:1316511744
Name:HARGETT, JARED (CRNA)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:HARGETT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9005 HARGETT ST
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:AL
Mailing Address - Zip Code:35091-2410
Mailing Address - Country:US
Mailing Address - Phone:205-641-5787
Mailing Address - Fax:
Practice Address - Street 1:3104 BLUE LAKE DRIVE, SUITE 110
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3524
Practice Address - Country:US
Practice Address - Phone:205-977-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL133654207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty