Provider Demographics
NPI:1154591055
Name:HURST, KRISTAL LAY
Entity type:Individual
Prefix:
First Name:KRISTAL
Middle Name:LAY
Last Name:HURST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTAL
Other - Middle Name:NICOLE
Other - Last Name:LAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:732 CLIFF TOP RD
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:TN
Mailing Address - Zip Code:37709-5921
Mailing Address - Country:US
Mailing Address - Phone:865-805-7657
Mailing Address - Fax:
Practice Address - Street 1:1079 E MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813
Practice Address - Country:US
Practice Address - Phone:423-318-7373
Practice Address - Fax:423-318-7474
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24117363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health