Healthcare Provider Details

I. General information

NPI: 1821902602
Provider Name (Legal Business Name): ERICA RENEE HURT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 ROYAL CHARTRES SQ W APT 205
CORDOVA TN
38018-4466
US

IV. Provider business mailing address

327 ROYAL CHARTRES SQ W APT 205
CORDOVA TN
38018-4466
US

V. Phone/Fax

Practice location:
  • Phone: 901-949-3419
  • Fax:
Mailing address:
  • Phone: 901-949-3419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number1052779
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: