Provider Demographics
NPI:1710229141
Name:HURST, MALLORY (MD)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:
Last Name:HURST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S CHURCH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4106
Mailing Address - Country:US
Mailing Address - Phone:870-934-1466
Mailing Address - Fax:
Practice Address - Street 1:800 S CHURCH ST STE 202
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-336-0277
Practice Address - Fax:870-932-5699
Is Sole Proprietor?:No
Enumeration Date:2013-03-24
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-10383207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology