Provider Demographics
NPI:1891711651
Name:HURT, KATHLYNN H (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHLYNN
Middle Name:H
Last Name:HURT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2285 CORPORATE CIR 200
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7759
Mailing Address - Country:US
Mailing Address - Phone:702-853-7451
Mailing Address - Fax:949-783-2880
Practice Address - Street 1:20950 N TATUM BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4200
Practice Address - Country:US
Practice Address - Phone:480-502-6651
Practice Address - Fax:480-513-8253
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2015-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2650363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP67150Medicare UPIN