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General NPI Number Information
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NPI Number | 1841247954
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Entity Type | Individual
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Provider Name | FRED THOMAS HURST JR. CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 68 REDFERN TRL
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City | PETAL
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State | MS
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Zip | 39465-9415
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Country | US
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Telephone | 601-310-6813
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Fax |
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Provider Business Mailing Address
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Address Line | 250 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4959
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Country | US
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Telephone |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 2023035281
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R861818
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 861818
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License Number State | IN
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