Healthcare Provider Details

I. General information

NPI: 1679834345
Provider Name (Legal Business Name): MELISSA MARIE HURST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 W ELK AVE
DUNCAN OK
73533-1569
US

IV. Provider business mailing address

1334 N HARVILLE RD
DUNCAN OK
73533-1514
US

V. Phone/Fax

Practice location:
  • Phone: 580-251-6822
  • Fax:
Mailing address:
  • Phone: 580-255-8564
  • Fax: 580-255-8640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29349
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: