=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154591055
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTAL LAY HURST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2008
-----------------------------------------------------
Last Update Date | 06/28/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1079 E MORRIS BLVD
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-318-7373
-----------------------------------------------------
Fax | 423-318-7474
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 732 CLIFF TOP RD
-----------------------------------------------------
City | BLAINE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37709-5921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-805-7657
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 24117
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------