Healthcare Provider Details

I. General information

NPI: 1114224169
Provider Name (Legal Business Name): STEPHANIE ANN HURST DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 MEDICAL PARK DR 4 EAST WVU HEALTHCARE OB/GYN
BRIDGEPORT WV
26330-9009
US

IV. Provider business mailing address

327 MEDICAL PARK DR 4 EAST WVU HEALTHCARE OB/GYN
BRIDGEPORT WV
26330-9009
US

V. Phone/Fax

Practice location:
  • Phone: 304-848-2150
  • Fax: 304-848-2153
Mailing address:
  • Phone: 304-848-2150
  • Fax: 304-848-2153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN107702
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number791406
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN148311
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN81471
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: