Healthcare Provider Details

I. General information

NPI: 1346914256
Provider Name (Legal Business Name): CARL DOUGLAS HURD PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 01/02/2023
Certification Date: 01/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14057 US HIGHWAY 17 STE 200
HAMPSTEAD NC
28443-3793
US

IV. Provider business mailing address

3555 HANSA DR
CASTLE HAYNE NC
28429-5863
US

V. Phone/Fax

Practice location:
  • Phone: 910-821-1418
  • Fax: 866-860-0997
Mailing address:
  • Phone: 706-830-0277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5014813
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5014813
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: