Provider Demographics
NPI:1194373142
Name:HURT, KELLI
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:HURT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8324 FOXWORTH TRL
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-3072
Mailing Address - Country:US
Mailing Address - Phone:865-356-0176
Mailing Address - Fax:
Practice Address - Street 1:8324 FOXWORTH TRL
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3072
Practice Address - Country:US
Practice Address - Phone:865-356-0176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program