Healthcare Provider Details

I. General information

NPI: 1750315834
Provider Name (Legal Business Name): KRISTEN M HURLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 15TH ST
PUEBLO CO
81003-2743
US

IV. Provider business mailing address

405 W 15TH ST
PUEBLO CO
81003-2743
US

V. Phone/Fax

Practice location:
  • Phone: 719-584-4306
  • Fax: 719-595-7886
Mailing address:
  • Phone: 719-584-4306
  • Fax: 719-595-7886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1220
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: