Provider Demographics
NPI:1093054538
Name:HURST, KATHY (APN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:HURST
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 PICKWICK ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-3519
Mailing Address - Country:US
Mailing Address - Phone:731-925-5054
Mailing Address - Fax:731-925-5699
Practice Address - Street 1:1410 PICKWICK ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-3519
Practice Address - Country:US
Practice Address - Phone:731-925-5054
Practice Address - Fax:731-925-5699
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN81722163W00000X
TNAPN 17354363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse