Healthcare Provider Details

I. General information

NPI: 1295070241
Provider Name (Legal Business Name): CYNTHIA JEAN HURST PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 W MAIN ST
BUCKHANNON WV
26201-2235
US

IV. Provider business mailing address

37 W MAIN ST
BUCKHANNON WV
26201-2235
US

V. Phone/Fax

Practice location:
  • Phone: 304-473-5600
  • Fax: 304-472-1341
Mailing address:
  • Phone: 304-473-5600
  • Fax: 304-472-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: