Provider Demographics
NPI:1992717615
Name:HURST, PAUL A (PA-C)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:HURST
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 W MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-9366
Mailing Address - Country:US
Mailing Address - Phone:920-433-9400
Mailing Address - Fax:920-455-9409
Practice Address - Street 1:1385 W MAIN AVE
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9366
Practice Address - Country:US
Practice Address - Phone:920-433-9400
Practice Address - Fax:920-455-9409
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1395363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41929200Medicaid
WI016307650Medicare ID - Type Unspecified