Basic Information
| Provider Information | |||||||||
| NPI: | 1073879631 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HURTS | ||||||||
| FirstName: | JONATHAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 OPELOUSAS ST | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706012641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374399983 | ||||||||
| FaxNumber: | 3373101161 | ||||||||
| Practice Location | |||||||||
| Address1: | 526 CROWLEY RAYNE HWY | ||||||||
| Address2: | |||||||||
| City: | CROWLEY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705268209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3377835519 | ||||||||
| FaxNumber: | 3377835521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2012 | ||||||||
| LastUpdateDate: | 10/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APO6695 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.