Provider Demographics
NPI:1760434229
Name:HURT, NANCY M (FNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:HURT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 NELSON DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:TN
Mailing Address - Zip Code:38011-6663
Mailing Address - Country:US
Mailing Address - Phone:901-872-8407
Mailing Address - Fax:901-872-8409
Practice Address - Street 1:8076 US HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-1734
Practice Address - Country:US
Practice Address - Phone:901-872-8407
Practice Address - Fax:901-872-8409
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000056165363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3347836Medicaid
TNS70118Medicare UPIN
TN3347836Medicaid