Healthcare Provider Details

I. General information

NPI: 1144975905
Provider Name (Legal Business Name): ZACHARY DOUGLAS HURLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2022
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TRILLION WAY SUITE 106
CORBIN KY
40701-8426
US

IV. Provider business mailing address

1901 CAMPUS PL
LOUISVILLE KY
40299-2308
US

V. Phone/Fax

Practice location:
  • Phone: 606-526-4070
  • Fax: 606-526-4072
Mailing address:
  • Phone: 502-253-4924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3090
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: