Healthcare Provider Details

I. General information

NPI: 1114455284
Provider Name (Legal Business Name): ADRIENNE ELIZABETH HURST LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADRIENNE ELIZABETH LUCKEY

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 06/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10731 CHAPMAN HWY
SEYMOUR TN
37865-4765
US

IV. Provider business mailing address

6350 W ANDREW JOHNSON HWY DEPT 100
TALBOTT TN
37877-8605
US

V. Phone/Fax

Practice location:
  • Phone: 865-573-0698
  • Fax: 865-573-3174
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN77280
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: