Provider Demographics
NPI:1588916340
Name:HURST, EMILY D (FNP-BC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:D
Last Name:HURST
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:DAWN
Other - Last Name:BETTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11115 PARKVIEW PLAZA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1701
Practice Address - Country:US
Practice Address - Phone:260-266-5400
Practice Address - Fax:260-425-5715
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004222A363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28168275AOtherINDIANA STATE NURSING BOARD-REGISTERED NURSE
IN5595716027OtherDOT
IN71004222BOtherINDIANA STATE NURSING BOARD-CSR PRESCRIPTIVE AUTHORITY
IN71004222AOtherINDIANA STATE NURSING BOARD-APN PRESCRIPTIVE AUTHORITY
2012008291OtherANCC CERTIFICATION