Healthcare Provider Details

I. General information

NPI: 1093482242
Provider Name (Legal Business Name): SAMANTHA DELYNN HURLBUT APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 08/25/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W 34TH ST STE 301
AUSTIN TX
78705-1217
US

IV. Provider business mailing address

12000 BONHAM RANCH RD
DRIPPING SPRINGS TX
78620-5133
US

V. Phone/Fax

Practice location:
  • Phone: 832-465-3142
  • Fax:
Mailing address:
  • Phone: 832-465-3142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1052242
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: