Provider Demographics
NPI:1285783845
Name:HURST, RACHEL LYN (PA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYN
Last Name:HURST
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LYN
Other - Last Name:SMALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 4024
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4024
Mailing Address - Country:US
Mailing Address - Phone:417-882-1207
Mailing Address - Fax:417-881-7268
Practice Address - Street 1:3801 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5210
Practice Address - Country:US
Practice Address - Phone:417-269-7728
Practice Address - Fax:417-269-7729
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007001661363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1076297OtherNCCPA BOARD CERTIFICATION
P00823594OtherRAILROAD MEDICARE-SJC
MOQ75949OtherUSPS (W/C)
MO0600288OtherUNITED HEALTH CARE
MO502277007Medicaid
WA0219383OtherDEBARTMENT OF LABOR WA
MO217261OtherBLUE CROSS/BLUE SHIELD
MO2565515OtherCOX HEALTH
MO431560263OtherTRICARE WEST
MO132300103Medicare PIN
WA0219383OtherDEBARTMENT OF LABOR WA
MO431560263OtherTRICARE WEST