Healthcare Provider Details

I. General information

NPI: 1265864680
Provider Name (Legal Business Name): CAREY D HURT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N PLUM ST
MOLINE KS
67353-9510
US

IV. Provider business mailing address

200 N PLUM ST P.O. BOX 155
MOLINE KS
67353-9510
US

V. Phone/Fax

Practice location:
  • Phone: 620-647-8109
  • Fax: 620-647-3638
Mailing address:
  • Phone: 620-647-8109
  • Fax: 620-647-3638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-76097-072
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: