Provider Demographics
NPI:1346273638
Name:HURST, KENDRA JOY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:JOY
Last Name:HURST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KENDRA
Other - Middle Name:JOY
Other - Last Name:OSBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6802 S OLYMPIA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1823
Mailing Address - Country:US
Mailing Address - Phone:918-447-9300
Mailing Address - Fax:918-447-9308
Practice Address - Street 1:6802 S OLYMPIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1823
Practice Address - Country:US
Practice Address - Phone:918-447-9300
Practice Address - Fax:918-447-9308
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1434363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200088050AMedicaid
OK200088050AMedicaid