MEDICARE: MRS. KELLEY PRIVETT KURTH RN, MSN, AGNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	5008906	NC

General Provider Information

NPI Number	:	1306211156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLEY PRIVETT KURTH RN, MSN, AGNP-C

Provider Business Mailing Address
First Line	:	224 BLUFFTON RD
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28115-5798
Country	:	US
Telephone Number	:	601-259-7009
Fax Number	:

Provider Business Practice Location Address
First Line	:	9920 KINCEY AVE STE 140
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-2401
Country	:	US
Telephone Number	:	704-820-4197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2015
Last Update Date	:	06/13/2024

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