Healthcare Provider Details

I. General information

NPI: 1366010886
Provider Name (Legal Business Name): JENNIFER SUE HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18434 BUDDY RILEY BLVD STE 2
MAGNOLIA TX
77354-5395
US

IV. Provider business mailing address

18434 BUDDY RILEY BLVD STE 2
MAGNOLIA TX
77354-5395
US

V. Phone/Fax

Practice location:
  • Phone: 281-259-8919
  • Fax:
Mailing address:
  • Phone: 281-259-8919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: