Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | NA | IA |
N | 207YP0228X | Pediatric Otolaryngology | 0437421 | KS |
N | 207YP0228X | Pediatric Otolaryngology | 2014018650 | MO |
Y | 207YP0228X | Pediatric Otolaryngology | R2130 | TX |
NPI | 1114190915 |
---|---|
Provider Name | Dr. Kristen Renee Hurst |
First Address | Nacogdoches, TX 75965 |
Second Address | Nacogdoches, TX 75965-2922 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2008 |
Last Update Date | 17/03/2018 |