Provider Demographics
NPI:1558300863
Name:HURST, KIMBERLY S (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:HURST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17717 MASONIC
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-3158
Mailing Address - Country:US
Mailing Address - Phone:586-294-0600
Mailing Address - Fax:
Practice Address - Street 1:17717 MASONIC
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-3158
Practice Address - Country:US
Practice Address - Phone:586-294-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003608363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant