Healthcare Provider Details

I. General information

NPI: 1851024004
Provider Name (Legal Business Name): KIMBERLY DAWN HURLEY DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 E RUSHOLME ST STE 207
DAVENPORT IA
52803-2400
US

IV. Provider business mailing address

5105 7TH AVE
MOLINE IL
61265-2710
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-8997
  • Fax:
Mailing address:
  • Phone: 309-373-0377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number122071
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA170192
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: