Healthcare Provider Details

I. General information

NPI: 1396635033
Provider Name (Legal Business Name): JASON W HURLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2025
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 AUSTON RD
SILVER POINT TN
38582-6118
US

IV. Provider business mailing address

4220 AUSTON RD
SILVER POINT TN
38582-6118
US

V. Phone/Fax

Practice location:
  • Phone: 931-979-4627
  • Fax:
Mailing address:
  • Phone: 931-979-4627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number38759
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: