Healthcare Provider Details

I. General information

NPI: 1790221901
Provider Name (Legal Business Name): KATHERINE LYNNE HURTT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 MEDICAL CENTER DR SW
FORT PAYNE AL
35968-3420
US

IV. Provider business mailing address

323 MEDICAL CENTER DR SW
FORT PAYNE AL
35968-3420
US

V. Phone/Fax

Practice location:
  • Phone: 256-844-2911
  • Fax: 256-844-2881
Mailing address:
  • Phone: 256-844-2911
  • Fax: 256-844-2881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-093084
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: