Healthcare Provider Details

I. General information

NPI: 1083597355
Provider Name (Legal Business Name): KIYANA M. HURT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9119 S EXCHANGE AVE
CHICAGO IL
60617-4225
US

IV. Provider business mailing address

22836 EAST DR
RICHTON PARK IL
60471-2312
US

V. Phone/Fax

Practice location:
  • Phone: 773-768-5000
  • Fax:
Mailing address:
  • Phone: 708-833-9383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209032320
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: