Provider Demographics
NPI:1407003585
Name:HURT, EMILY SUSANNE (APN)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:SUSANNE
Last Name:HURT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:EMILY
Other - Middle Name:SUSANNE
Other - Last Name:HURT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:920 UNION ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3526
Mailing Address - Country:US
Mailing Address - Phone:870-219-0419
Mailing Address - Fax:870-910-5599
Practice Address - Street 1:920 UNION ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3526
Practice Address - Country:US
Practice Address - Phone:870-219-0419
Practice Address - Fax:870-910-5599
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA03145OtherADVANCED PRACTICE NURSE ARKANSAS