Provider Demographics
NPI:1790885762
Name:HURST, NATASHA WALDENMAYER (PA)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:WALDENMAYER
Last Name:HURST
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-489-5730
Mailing Address - Fax:502-489-5733
Practice Address - Street 1:101 STONECREST RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8169
Practice Address - Country:US
Practice Address - Phone:502-633-2233
Practice Address - Fax:502-633-3833
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC031363A00000X
KYPA998363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q72354Medicare UPIN
KY0694539Medicare PIN