=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669943320
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARI LOUCYE HURT FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2018
-----------------------------------------------------
Last Update Date | 09/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1968 PEACHTREE RD NW BLDG 775TH
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30309-1281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-605-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1968 PEACHTREE ROAD NW 77 BLDG, 5TH FLOOR
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-605-4358
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN195084
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------