Healthcare Provider Details

I. General information

NPI: 1699082974
Provider Name (Legal Business Name): MELISSA ANN HURST PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ANN HURST

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 HARPER AVE NW
LENOIR NC
28645-5083
US

IV. Provider business mailing address

810 HARPER AVE NW
LENOIR NC
28645-5083
US

V. Phone/Fax

Practice location:
  • Phone: 828-754-8565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number508
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-06905
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: