Healthcare Provider Details

I. General information

NPI: 1578692596
Provider Name (Legal Business Name): DEBRA ANN HURST R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 E POPLAR AVE
SELMER TN
38375-1800
US

IV. Provider business mailing address

PO BOX 424
SELMER TN
38375-0424
US

V. Phone/Fax

Practice location:
  • Phone: 731-645-3474
  • Fax: 731-645-4530
Mailing address:
  • Phone: 731-645-3474
  • Fax: 731-645-4530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0000090932
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: