Healthcare Provider Details

I. General information

NPI: 1255015756
Provider Name (Legal Business Name): CYNTHIA MARIE HURST RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 CARTER AVE
ASHLAND KY
41101-7827
US

IV. Provider business mailing address

105 NEDRA DR
BARBOURSVILLE WV
25504-1020
US

V. Phone/Fax

Practice location:
  • Phone: 304-320-8375
  • Fax:
Mailing address:
  • Phone: 304-320-8375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number99593
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: