Healthcare Provider Details

I. General information

NPI: 1093520900
Provider Name (Legal Business Name): MRS. SHMIEKA MICHELLE HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2025
Last Update Date: 02/08/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 E MAIN ST
LEXINGTON KY
40502-1668
US

IV. Provider business mailing address

710 E MAIN ST
LEXINGTON KY
40502-1668
US

V. Phone/Fax

Practice location:
  • Phone: 877-290-4149
  • Fax: 877-934-2359
Mailing address:
  • Phone: 877-290-4149
  • Fax: 877-934-2359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: