Provider Demographics
NPI:1245059997
Name:HURT, KIZZY CHAUNTA (RN, BSN)
Entity type:Individual
Prefix:
First Name:KIZZY
Middle Name:CHAUNTA
Last Name:HURT
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:KIZZY
Other - Middle Name:CHAUNTA
Other - Last Name:RAGLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:3608 WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1830
Mailing Address - Country:US
Mailing Address - Phone:502-356-6392
Mailing Address - Fax:
Practice Address - Street 1:801 W BROADWAY STE 4
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2236
Practice Address - Country:US
Practice Address - Phone:502-416-8783
Practice Address - Fax:502-305-6578
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1152844163WA0400X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)