Healthcare Provider Details

I. General information

NPI: 1538042502
Provider Name (Legal Business Name): JENNIFER HURST DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 S SILVER SPRINGS RD
CAPE GIRARDEAU MO
63703-6309
US

IV. Provider business mailing address

477 HYDE PARK
JACKSON MO
63755-8725
US

V. Phone/Fax

Practice location:
  • Phone: 573-651-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2025026318
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: