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General NPI Number Information
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NPI Number | 1124821202
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Entity Type | Individual
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Provider Name | JACQLYN NICOLE HURST APRN-PNP
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Gender | Female
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 715 W MAIN ST
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City | JENKS
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State | OK
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Zip | 74037-3554
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Country | US
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Telephone | 918-745-0501
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Fax |
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Provider Business Mailing Address
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Address Line | 5025 S IRVINGTON CT
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City | TULSA
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State | OK
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Zip | 74135-6816
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Country | US
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Telephone | 918-520-7078
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 222535
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License Number State | OK
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