Healthcare Provider Details

I. General information

NPI: 1225498066
Provider Name (Legal Business Name): KIMBERLY HURT R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2016
Last Update Date: 03/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NICHOLS RD
HAUPPAUGE NY
11788-5016
US

IV. Provider business mailing address

500 NICHOLS RD
HAUPPAUGE NY
11788-5016
US

V. Phone/Fax

Practice location:
  • Phone: 631-786-4129
  • Fax:
Mailing address:
  • Phone: 631-786-4129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number578044
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: