Provider Demographics
NPI:1699147645
Name:HURST, LONNIE TYLER (BSMICROBIOLOGY)
Entity type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:TYLER
Last Name:HURST
Suffix:
Gender:M
Credentials:BSMICROBIOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873-4429
Mailing Address - Country:US
Mailing Address - Phone:325-513-9226
Mailing Address - Fax:
Practice Address - Street 1:1100 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:OK
Practice Address - Zip Code:74873-4429
Practice Address - Country:US
Practice Address - Phone:325-513-9226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling