MEDICARE: MRS. KATHLYNN H HURT PA-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	363AM0700X	Medical Physician Assistant	2650	AZ

General Provider Information

NPI Number	:	1891711651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLYNN H HURT PA-C

Provider Business Mailing Address
First Line	:	2285 CORPORATE CIR 200
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-7759
Country	:	US
Telephone Number	:	702-853-7451
Fax Number	:	949-783-2880

Provider Business Practice Location Address
First Line	:	20950 N TATUM BLVD
Second Line	:	SUITE 350
City	:	PHOENIX
State	:	AZ
Zip	:	85050-4200
Country	:	US
Telephone Number	:	480-502-6651
Fax Number	:	480-513-8253

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	11/01/2015

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