Healthcare Provider Details

I. General information

NPI: 1427690635
Provider Name (Legal Business Name): KAYLEY E HURT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL CENTER DR STE 200
GADSDEN AL
35903-1103
US

IV. Provider business mailing address

300 MEDICAL CENTER DR STE 200
GADSDEN AL
35903-1103
US

V. Phone/Fax

Practice location:
  • Phone: 256-494-4646
  • Fax:
Mailing address:
  • Phone: 256-494-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-142927
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-142927
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: