Healthcare Provider Details

I. General information

NPI: 1427814433
Provider Name (Legal Business Name): HALEY HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 WERK RD
CINCINNATI OH
45248-6229
US

IV. Provider business mailing address

4209 APPLEGATE AVE APT 2
CINCINNATI OH
45211-5321
US

V. Phone/Fax

Practice location:
  • Phone: 513-800-3150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.004344
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: