Healthcare Provider Details

I. General information

NPI: 1093054538
Provider Name (Legal Business Name): KATHY HURST APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 PICKWICK ST
SAVANNAH TN
38372-3519
US

IV. Provider business mailing address

1410 PICKWICK ST
SAVANNAH TN
38372-3519
US

V. Phone/Fax

Practice location:
  • Phone: 731-925-5054
  • Fax: 731-925-5699
Mailing address:
  • Phone: 731-925-5054
  • Fax: 731-925-5699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN81722
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN 17354
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: