Healthcare Provider Details

I. General information

NPI: 1417151739
Provider Name (Legal Business Name): CHRISTOPHER HURLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 E BROADWAY
LOUISVILLE KY
40204-1037
US

IV. Provider business mailing address

101 W MUHAMMAD ALI BLVD
LOUISVILLE KY
40202-1423
US

V. Phone/Fax

Practice location:
  • Phone: 502-589-8600
  • Fax: 502-589-8745
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: