Healthcare Provider Details

I. General information

NPI: 1538553060
Provider Name (Legal Business Name): KATHRYN NICOLE HURST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1577 COMMERCIAL STREET FL 2
PORTLAND ME
04102
US

IV. Provider business mailing address

1577 CONGRESS ST
PORTLAND ME
04102-2169
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-5790
  • Fax:
Mailing address:
  • Phone: 207-662-5522
  • Fax: 207-774-1814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberMT215535
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberMD24761
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: