Healthcare Provider Details

I. General information

NPI: 1821801234
Provider Name (Legal Business Name): MRS. MORTICIA HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6008 GORDON ST
FORT SILL OK
73503-4481
US

IV. Provider business mailing address

4301 WILSON ST
FORT SILL OK
73503-4472
US

V. Phone/Fax

Practice location:
  • Phone: 580-558-7259
  • Fax:
Mailing address:
  • Phone: 580-558-7259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN0080468
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: