Provider Demographics
NPI:1558712273
Name:HURT, JOHNNA
Entity Type:Individual
Prefix:
First Name:JOHNNA
Middle Name:
Last Name:HURT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S 4TH ST
Mailing Address - Street 2:STE E
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-3460
Mailing Address - Country:US
Mailing Address - Phone:405-222-8268
Mailing Address - Fax:
Practice Address - Street 1:210 S 4TH ST
Practice Address - Street 2:STE E
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-3460
Practice Address - Country:US
Practice Address - Phone:405-222-8268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator