Healthcare Provider Details

I. General information

NPI: 1891711651
Provider Name (Legal Business Name): KATHLYNN H HURT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20950 N TATUM BLVD SUITE 350
PHOENIX AZ
85050-4200
US

IV. Provider business mailing address

2285 CORPORATE CIR 200
HENDERSON NV
89074-7759
US

V. Phone/Fax

Practice location:
  • Phone: 480-502-6651
  • Fax: 480-513-8253
Mailing address:
  • Phone: 702-853-7451
  • Fax: 949-783-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2650
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: