Healthcare Provider Details

I. General information

NPI: 1669052122
Provider Name (Legal Business Name): KELLY ELIZABETH HURST APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 04/09/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 STATE HIGHWAY
ELIZABETHTOWN KY
42701
US

IV. Provider business mailing address

234 AHLENA WAY
SPRINGFIELD KY
40069-9568
US

V. Phone/Fax

Practice location:
  • Phone: 270-765-5921
  • Fax:
Mailing address:
  • Phone: 270-940-0532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015850
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: