Healthcare Provider Details

I. General information

NPI: 1295585875
Provider Name (Legal Business Name): ALLISON HURST QUESENBERRY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON PAIGE HURST

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CARROLL DRIVE
FRIES VA
24330
US

IV. Provider business mailing address

3702 POPLAR KNOB RD
GALAX VA
24333-6463
US

V. Phone/Fax

Practice location:
  • Phone: 888-908-4788
  • Fax:
Mailing address:
  • Phone: 276-229-8462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86107987
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: