Healthcare Provider Details

I. General information

NPI: 1164388161
Provider Name (Legal Business Name): ELWOOD JAMES HURLEY FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156 N BROOK ST
KINGMAN AZ
86401-4362
US

IV. Provider business mailing address

3156 N BROOK ST
KINGMAN AZ
86401-4362
US

V. Phone/Fax

Practice location:
  • Phone: 928-530-7870
  • Fax:
Mailing address:
  • Phone: 928-530-7870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number231557
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: