Provider Demographics
NPI:1306967906
Name:HURLEY, KATHLEEN (CPNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:HURLEY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 LANVALE DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4707
Mailing Address - Country:US
Mailing Address - Phone:314-454-4279
Mailing Address - Fax:314-454-4280
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:SUITE 11 WEST 45
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-4279
Practice Address - Fax:314-454-4280
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002011650363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics