Provider Demographics
NPI:1558165696
Name:HURST, KEENAN TIMOTHY JR
Entity type:Individual
Prefix:
First Name:KEENAN
Middle Name:TIMOTHY
Last Name:HURST
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VEEDA CT
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-2082
Mailing Address - Country:US
Mailing Address - Phone:504-259-0400
Mailing Address - Fax:
Practice Address - Street 1:1 VEEDA CT
Practice Address - Street 2:
Practice Address - City:RIVER RIDGE
Practice Address - State:LA
Practice Address - Zip Code:70123-2082
Practice Address - Country:US
Practice Address - Phone:504-259-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program