Healthcare Provider Details

I. General information

NPI: 1821735747
Provider Name (Legal Business Name): BRAXTON HURLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WALNUT ST
OWENSBORO KY
42301-2956
US

IV. Provider business mailing address

1100 WALNUT ST
OWENSBORO KY
42301-2956
US

V. Phone/Fax

Practice location:
  • Phone: 270-689-6500
  • Fax:
Mailing address:
  • Phone: 270-689-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: