Healthcare Provider Details

I. General information

NPI: 1386920924
Provider Name (Legal Business Name): GAIL A HURT ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD SUITE 1015B
SAINT LOUIS MO
63141-8232
US

IV. Provider business mailing address

621 S NEW BALLAS RD SUITE 1015B
SAINT LOUIS MO
63141-8232
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-4652
  • Fax: 314-251-5715
Mailing address:
  • Phone: 314-251-4652
  • Fax: 314-251-5715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2011035325
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: