Healthcare Provider Details

I. General information

NPI: 1194900902
Provider Name (Legal Business Name): ABBY HURST R.D. L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 W GAMBELS CT
ANDOVER KS
67002-7524
US

IV. Provider business mailing address

1411 W GAMBELS CT
ANDOVER KS
67002-7524
US

V. Phone/Fax

Practice location:
  • Phone: 903-821-3191
  • Fax:
Mailing address:
  • Phone: 903-821-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3427
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: