Healthcare Provider Details

I. General information

NPI: 1649308552
Provider Name (Legal Business Name): KATHERINE JEAN HURST APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2379 BUFFALO RD
LAWRENCEBURG TN
38464-4810
US

IV. Provider business mailing address

205 CAPERTON AVE
LAWRENCEBURG TN
38464-3444
US

V. Phone/Fax

Practice location:
  • Phone: 931-762-9406
  • Fax:
Mailing address:
  • Phone: 931-242-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0000146158
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28664
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: