Healthcare Provider Details

I. General information

NPI: 1265887319
Provider Name (Legal Business Name): CINDY HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CINDY RAE HURST RN, AGACNP-C

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 OVERLAND AVE
BURLEY ID
83318-2436
US

IV. Provider business mailing address

436 S 750 E
BURLEY ID
83318-5661
US

V. Phone/Fax

Practice location:
  • Phone: 208-825-6193
  • Fax: 208-825-6199
Mailing address:
  • Phone: 208-431-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberN-20719
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53805
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: