Healthcare Provider Details

I. General information

NPI: 1972855294
Provider Name (Legal Business Name): KELLEY M HURET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5969 E BROAD ST SUITE 302
COLUMBUS OH
43213-1546
US

IV. Provider business mailing address

5969 E BROAD ST SUITE 302
COLUMBUS OH
43213-1546
US

V. Phone/Fax

Practice location:
  • Phone: 614-751-6500
  • Fax: 614-751-6506
Mailing address:
  • Phone: 614-751-6500
  • Fax: 614-751-6506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-01394
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: