Healthcare Provider Details

I. General information

NPI: 1700643897
Provider Name (Legal Business Name): SHELIA HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W 3RD ST
COOKEVILLE TN
38501-2495
US

IV. Provider business mailing address

100 W 3RD ST
COOKEVILLE TN
38501-2495
US

V. Phone/Fax

Practice location:
  • Phone: 931-528-9047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number35828
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: