Healthcare Provider Details

I. General information

NPI: 1437043148
Provider Name (Legal Business Name): KHAMMI HURD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 CEDARGROVE DR
AUSTIN TX
78744-2917
US

IV. Provider business mailing address

4705 CEDARGROVE DR
AUSTIN TX
78744-2917
US

V. Phone/Fax

Practice location:
  • Phone: 918-604-1222
  • Fax:
Mailing address:
  • Phone: 918-604-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number120930
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: