Healthcare Provider Details

I. General information

NPI: 1467896449
Provider Name (Legal Business Name): FELICIA BETH HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W MAIN ST STE 260
ARDMORE OK
73401-6300
US

IV. Provider business mailing address

333 W MAIN ST STE 260
ARDMORE OK
73401-6300
US

V. Phone/Fax

Practice location:
  • Phone: 580-224-2929
  • Fax:
Mailing address:
  • Phone: 580-224-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: