Healthcare Provider Details

I. General information

NPI: 1083278766
Provider Name (Legal Business Name): MELISSA KAYE HURST LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2019
Last Update Date: 04/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

3809 WINTERBROOK DR
BENTON AR
72015-4946
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-7000
  • Fax:
Mailing address:
  • Phone: 479-462-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4432-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: