Healthcare Provider Details

I. General information

NPI: 1285186759
Provider Name (Legal Business Name): DAWN M HURT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 OUTPATIENT CIRCLE
LITTLE ROCK AR
72205-7220
US

IV. Provider business mailing address

PO BOX 251420
LITTLE ROCK AR
72225-1420
US

V. Phone/Fax

Practice location:
  • Phone: 501-603-1900
  • Fax:
Mailing address:
  • Phone: 501-686-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA004925
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: