Provider Demographics
NPI:1174024921
Name:HURT, ANITA MAE (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:MAE
Last Name:HURT
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 TYLER RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-7161
Mailing Address - Country:US
Mailing Address - Phone:731-968-3646
Mailing Address - Fax:
Practice Address - Street 1:200 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-2038
Practice Address - Country:US
Practice Address - Phone:731-968-3646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000176660163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical