Provider Demographics
NPI:1083814073
Name:HURST, TWYLA (FNP)
Entity Type:Individual
Prefix:
First Name:TWYLA
Middle Name:
Last Name:HURST
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 BARKSDALE BLVD.
Mailing Address - Street 2:BOSSIER FAMILY MEDICAL CLINIC
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112
Mailing Address - Country:US
Mailing Address - Phone:318-841-5541
Mailing Address - Fax:318-841-5545
Practice Address - Street 1:3330 BARKSDALE BLVD
Practice Address - Street 2:BOSSIER FAMILY MEDICAL CLINIC
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-3802
Practice Address - Country:US
Practice Address - Phone:318-841-5541
Practice Address - Fax:318-841-5545
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily