Healthcare Provider Details

I. General information

NPI: 1881092534
Provider Name (Legal Business Name): KYLE HURT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6908 30TH AVE S
SEATTLE WA
98108-3768
US

IV. Provider business mailing address

12430 83RD AVE S
SEATTLE WA
98178-4918
US

V. Phone/Fax

Practice location:
  • Phone: 206-930-1548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG60527494
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: