Provider Demographics
NPI:1326086752
Name:HURT, CHRISTINE M (RN, BC, FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:HURT
Suffix:
Gender:F
Credentials:RN, BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 DALE LN
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MO
Mailing Address - Zip Code:65018-1158
Mailing Address - Country:US
Mailing Address - Phone:573-796-4379
Mailing Address - Fax:
Practice Address - Street 1:875 STATE ROUTE 5
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:MO
Practice Address - Zip Code:65081-8441
Practice Address - Country:US
Practice Address - Phone:660-433-5541
Practice Address - Fax:660-433-5717
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO113714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO429989510Medicaid
MOS56883Medicare UPIN