Healthcare Provider Details

I. General information

NPI: 1003769530
Provider Name (Legal Business Name): KEELIN ELISABETH HURTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC STREET BOX 357134
SEATTLE WA
98195
US

IV. Provider business mailing address

1959 NE PACIFIC STREET BOX 357134
SEATTLE WA
98195
US

V. Phone/Fax

Practice location:
  • Phone: 860-917-5148
  • Fax:
Mailing address:
  • Phone: 860-917-5148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEUW.DR.70102467
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: