Provider Demographics
NPI:1598179293
Name:HEGARTY, JACQUELINE TEMPLE KELLY (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:TEMPLE KELLY
Last Name:HEGARTY
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Gender:F
Credentials:MD
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Mailing Address - Street 1:640 JACKSON ST
Mailing Address - Street 2:MC 11102F
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2502
Mailing Address - Country:US
Mailing Address - Phone:651-254-3666
Mailing Address - Fax:651-254-5216
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:MC 11102F
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-3666
Practice Address - Fax:651-254-5216
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2019-05-10
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Provider Licenses
StateLicense IDTaxonomies
WI67298207P00000X
MN62010207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine