Provider Demographics
NPI:1194260703
Name:HURST, KENNETH BRIAN (APRN-CNP)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:BRIAN
Last Name:HURST
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31349 W COUNTY ROAD 1235
Mailing Address - Street 2:
Mailing Address - City:QUINTON
Mailing Address - State:OK
Mailing Address - Zip Code:74561-1012
Mailing Address - Country:US
Mailing Address - Phone:918-232-3159
Mailing Address - Fax:
Practice Address - Street 1:550 W SHAWNEE ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-4144
Practice Address - Country:US
Practice Address - Phone:918-910-5186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK205720363LF0000X
OK77838163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency