Healthcare Provider Details

I. General information

NPI: 1407762123
Provider Name (Legal Business Name): MIKAYLA HURLEY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FLORIST LANE
CYCLONE WV
24827
US

IV. Provider business mailing address

PO BOX 262
CYCLONE WV
24827-0262
US

V. Phone/Fax

Practice location:
  • Phone: 304-890-8090
  • Fax:
Mailing address:
  • Phone: 304-890-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: