Provider Demographics
NPI:1295489680
Name:THURMAN, MISTY F
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:F
Last Name:THURMAN
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 1:7065 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-4130
Mailing Address - Country:US
Mailing Address - Phone:409-549-1086
Mailing Address - Fax:
Practice Address - Street 1:2820 MERRIMAN ST
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-5309
Practice Address - Country:US
Practice Address - Phone:409-722-7641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19160235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist