Provider Demographics
NPI:1235307810
Name:HURLES, RICHARD TODD (CRNA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:TODD
Last Name:HURLES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:KY
Mailing Address - Zip Code:41094-7814
Mailing Address - Country:US
Mailing Address - Phone:859-250-3939
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:288 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:KY
Practice Address - Zip Code:41094
Practice Address - Country:US
Practice Address - Phone:859-250-3939
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5593A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200979270A (KOHMG)Medicaid
KY7100085250Medicaid
KY7100085250Medicaid
IN200979270A (KOHMG)Medicaid
KYK017742 (KOHMG)Medicare PIN