Healthcare Provider Details

I. General information

NPI: 1073879631
Provider Name (Legal Business Name): JONATHAN HURTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 CROWLEY RAYNE HWY
CROWLEY LA
70526-8209
US

IV. Provider business mailing address

2000 OPELOUSAS ST
LAKE CHARLES LA
70601-2641
US

V. Phone/Fax

Practice location:
  • Phone: 337-783-5519
  • Fax: 337-783-5521
Mailing address:
  • Phone: 337-439-9983
  • Fax: 337-310-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPO6695
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: