Healthcare Provider Details

I. General information

NPI: 1275816902
Provider Name (Legal Business Name): JEREMY LEE HURST RN, MSN, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 06/07/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 E GALA ST STE 3
MERIDIAN ID
83642-7692
US

IV. Provider business mailing address

2491 N TWEEDBROOK AVE
MERIDIAN ID
83646-5351
US

V. Phone/Fax

Practice location:
  • Phone: 208-888-5848
  • Fax:
Mailing address:
  • Phone: 775-625-0386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23474-A
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP-1114A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: