Healthcare Provider Details

I. General information

NPI: 1073855763
Provider Name (Legal Business Name): NICHOLAS HURST MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NICK HURST MD, MS

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N ORANGE ST STE 202
MISSOULA MT
59802-2951
US

IV. Provider business mailing address

PO BOX 12
LIBERTY LAKE WA
99019-0012
US

V. Phone/Fax

Practice location:
  • Phone: 406-377-3362
  • Fax:
Mailing address:
  • Phone: 866-747-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9460245-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number9460245-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMED-PHYS-LIC-121870
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: