Healthcare Provider Details

I. General information

NPI: 1285283218
Provider Name (Legal Business Name): SIERRA HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 05/02/2021
Certification Date: 05/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 E DUBLIN GRANVILLE RD STE G
WORTHINGTON OH
43085-3183
US

IV. Provider business mailing address

445 E DUBLIN GRANVILLE RD STE G
WORTHINGTON OH
43085-3183
US

V. Phone/Fax

Practice location:
  • Phone: 614-844-2800
  • Fax: 614-844-6548
Mailing address:
  • Phone: 614-844-2800
  • Fax: 614-844-6548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: