Healthcare Provider Details

I. General information

NPI: 1003683053
Provider Name (Legal Business Name): LARRIYAN HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 MACARTHUR BLVD APT 36
NEW ORLEANS LA
70131-7004
US

IV. Provider business mailing address

PO BOX 770978
NEW ORLEANS LA
70177-0978
US

V. Phone/Fax

Practice location:
  • Phone: 504-205-1686
  • Fax:
Mailing address:
  • Phone: 504-205-1686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: