Provider Demographics
NPI:1891321816
Name:HURST, KADIJA
Entity Type:Individual
Prefix:MRS
First Name:KADIJA
Middle Name:
Last Name:HURST
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KADIJA
Other - Middle Name:
Other - Last Name:PEART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6016 YELLOW ROSE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-1156
Mailing Address - Country:US
Mailing Address - Phone:850-525-8518
Mailing Address - Fax:
Practice Address - Street 1:5151 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8721
Practice Address - Country:US
Practice Address - Phone:850-416-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-21
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9384844163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse