Provider Demographics
NPI:1902933195
Name:HARGENS, TERRY W
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:W
Last Name:HARGENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SEARS CT
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-2547
Mailing Address - Country:US
Mailing Address - Phone:319-795-2033
Mailing Address - Fax:
Practice Address - Street 1:2 SEARS CT
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-2547
Practice Address - Country:US
Practice Address - Phone:319-795-2033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX650606367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCO8034H1Medicaid
TXCO8034H1Medicaid