Healthcare Provider Details

I. General information

NPI: 1710996574
Provider Name (Legal Business Name): VIRGINIA LUACES HURST M.A., CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 MELTON VIEW LN
KNOXVILLE TN
37931-2039
US

IV. Provider business mailing address

10900 MELTON VIEW LN
KNOXVILLE TN
37931-2039
US

V. Phone/Fax

Practice location:
  • Phone: 865-924-5199
  • Fax:
Mailing address:
  • Phone: 865-924-5199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2396
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: