Healthcare Provider Details

I. General information

NPI: 1013788363
Provider Name (Legal Business Name): KEVIN B HURLEY SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 CONNECTICUT AVE NW APT 326
WASHINGTON DC
20008-6015
US

IV. Provider business mailing address

4545 CONNECTICUT AVE NW
WASHINGTON DC
20008-6042
US

V. Phone/Fax

Practice location:
  • Phone: 202-470-8615
  • Fax:
Mailing address:
  • Phone: 202-470-8615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: