Healthcare Provider Details

I. General information

NPI: 1306642798
Provider Name (Legal Business Name): ASHLEY RENEE' HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 BAYOU PINES EAST DR STE C
LAKE CHARLES LA
70601-7196
US

IV. Provider business mailing address

416 S SHERMAN AVE APT C
IOWA LA
70647-7236
US

V. Phone/Fax

Practice location:
  • Phone: 337-433-3292
  • Fax:
Mailing address:
  • Phone: 337-275-7119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: