Healthcare Provider Details

I. General information

NPI: 1033635396
Provider Name (Legal Business Name): EMILY NICOLE HURST M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 FAYETTEVILLE RD
VAN BUREN AR
72956-3423
US

IV. Provider business mailing address

630 CHAPEN WAY
ALMA AR
72921-8502
US

V. Phone/Fax

Practice location:
  • Phone: 268-294-9479
  • Fax:
Mailing address:
  • Phone: 479-462-9135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberP9195
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: