Healthcare Provider Details

I. General information

NPI: 1619077807
Provider Name (Legal Business Name): COLEEN MERSAIDES HURST PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20935 US HIGHWAY 281 N
SAN ANTONIO TX
78258-7587
US

IV. Provider business mailing address

18915 SALADO CYN
SAN ANTONIO TX
78258-1634
US

V. Phone/Fax

Practice location:
  • Phone: 210-424-0089
  • Fax:
Mailing address:
  • Phone: 210-233-1886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: