Provider Demographics
NPI:1487634374
Name:HURST, JESSICA LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:HURST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:MONETTE
Mailing Address - State:AR
Mailing Address - Zip Code:72447-0098
Mailing Address - Country:US
Mailing Address - Phone:870-486-2162
Mailing Address - Fax:870-762-6688
Practice Address - Street 1:1401 E MOULTRIE DR
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-6822
Practice Address - Country:US
Practice Address - Phone:870-762-5000
Practice Address - Fax:870-762-6688
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X557Medicare ID - Type Unspecified