Provider Demographics
NPI:1063502466
Name:HURLEY, KATHLEEN BROOKS (APRN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:BROOKS
Last Name:HURLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4509 HORNBEAM DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-1416
Mailing Address - Country:US
Mailing Address - Phone:301-461-0953
Mailing Address - Fax:301-924-0131
Practice Address - Street 1:4509 HORNBEAM DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-1416
Practice Address - Country:US
Practice Address - Phone:301-461-0953
Practice Address - Fax:301-924-0131
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR097897364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPR19KBOtherCAREFIRST- RNCS
MD490423Medicare PIN