Healthcare Provider Details

I. General information

NPI: 1942674882
Provider Name (Legal Business Name): ZACHARY RYAN HURT ND, FNP,LAC, RN, BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2015
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 5TH ST SW
ROANOKE VA
24016-3912
US

IV. Provider business mailing address

708 5TH ST SW
ROANOKE VA
24016-3912
US

V. Phone/Fax

Practice location:
  • Phone: 864-554-7190
  • Fax:
Mailing address:
  • Phone: 864-554-7190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121001024
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001310221
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024190496
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: