Healthcare Provider Details

I. General information

NPI: 1699593665
Provider Name (Legal Business Name): KRISTIN HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 MEMORIAL CT
ELIZABETHTOWN KY
42701-2525
US

IV. Provider business mailing address

3384 OTTER CREEK DR
LEXINGTON KY
40515-5934
US

V. Phone/Fax

Practice location:
  • Phone: 844-443-3255
  • Fax:
Mailing address:
  • Phone: 859-213-5727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255569
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: