Healthcare Provider Details

I. General information

NPI: 1154591055
Provider Name (Legal Business Name): KRISTAL LAY HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTAL NICOLE LAY

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1079 E MORRIS BLVD
MORRISTOWN TN
37813
US

IV. Provider business mailing address

732 CLIFF TOP RD
BLAINE TN
37709-5921
US

V. Phone/Fax

Practice location:
  • Phone: 423-318-7373
  • Fax: 423-318-7474
Mailing address:
  • Phone: 865-805-7657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number24117
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: