Healthcare Provider Details

I. General information

NPI: 1962850776
Provider Name (Legal Business Name): DUSTIN HURTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 S CHESTNUT ST
ELLENSBURG WA
98926-3875
US

IV. Provider business mailing address

3800 SUMMITVIEW AVE
YAKIMA WA
98902-2715
US

V. Phone/Fax

Practice location:
  • Phone: 509-933-8693
  • Fax: 509-933-8694
Mailing address:
  • Phone: 509-248-7849
  • Fax: 509-248-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60776125
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: