Healthcare Provider Details

I. General information

NPI: 1639488950
Provider Name (Legal Business Name): ROBERT KENNETH HURST NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 E RIVERSIDE DR STE 302
ST GEORGE UT
84790-8722
US

IV. Provider business mailing address

230 N 1680 E STE I1
ST GEORGE UT
84790-2586
US

V. Phone/Fax

Practice location:
  • Phone: 435-652-6024
  • Fax: 435-652-6025
Mailing address:
  • Phone: 435-652-6024
  • Fax: 435-652-6025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6154039-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: