Healthcare Provider Details

I. General information

NPI: 1639377021
Provider Name (Legal Business Name): KATHERINE L HURST M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 HOSPITAL RD
ATWATER CA
95301-5173
US

IV. Provider business mailing address

3605 HOSPITAL RD
ATWATER CA
95301-5173
US

V. Phone/Fax

Practice location:
  • Phone: 209-381-2027
  • Fax:
Mailing address:
  • Phone: 209-381-2027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number157777
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38804
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: