Healthcare Provider Details

I. General information

NPI: 1033942537
Provider Name (Legal Business Name): KIERSTON HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 NORTHWEST EXPY
ATLANTA GA
30341
US

IV. Provider business mailing address

235 PHARR RD NE APT 2309
ATLANTA GA
30305-2497
US

V. Phone/Fax

Practice location:
  • Phone: 678-548-8956
  • Fax:
Mailing address:
  • Phone: 706-330-3549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN266868
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN266868
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: