Provider Demographics
NPI:1568158509
Name:HURST, MORIAH ELIZABETH (BS)
Entity Type:Individual
Prefix:
First Name:MORIAH
Middle Name:ELIZABETH
Last Name:HURST
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5114 EMERALD STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:MS
Mailing Address - Zip Code:39652-8160
Mailing Address - Country:US
Mailing Address - Phone:601-395-5778
Mailing Address - Fax:
Practice Address - Street 1:59335 RIVER WEST DR STE B
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-6553
Practice Address - Country:US
Practice Address - Phone:225-372-2693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator