Healthcare Provider Details

I. General information

NPI: 1689363848
Provider Name (Legal Business Name): KARA HURST MSW, APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 TRI PARK WAY
APPLETON WI
54914-1658
US

IV. Provider business mailing address

1232 SHADOW RIDGE WAY APT 5
DE PERE WI
54115-7627
US

V. Phone/Fax

Practice location:
  • Phone: 920-831-0070
  • Fax:
Mailing address:
  • Phone: 920-664-0564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number134115-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: