Healthcare Provider Details

I. General information

NPI: 1134365950
Provider Name (Legal Business Name): KIMBERLY HURTLEY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY HALLGREN APN

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38400 BOB WILSON DR
SAN DIEGO CA
92134-0001
US

IV. Provider business mailing address

38400 BOB WILSON DR
SAN DIEGO CA
92134-0001
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-7576
  • Fax:
Mailing address:
  • Phone: 619-532-7576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18599
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209007393
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: