Healthcare Provider Details

I. General information

NPI: 1235307810
Provider Name (Legal Business Name): RICHARD TODD HURLES C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 UNIVERSITY DR
WALTON KY
41094
US

IV. Provider business mailing address

288 UNIVERSITY DR
WALTON KY
41094-7814
US

V. Phone/Fax

Practice location:
  • Phone: 859-250-3939
  • Fax: --
Mailing address:
  • Phone: 859-250-3939
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5593A
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: