Individual
KELLY HURST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHMP
Contact information
Practice address
23715 MERCANTILE RD STE A203, BEACHWOOD, OH 44122-5918
(216) 292-2880
Mailing address
23715 MERCANTILE RD STE A203, BEACHWOOD, OH 44122-5918
(216) 292-2880
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
RN.368487
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN.382670
OH
Other
Enumeration date
01/23/2020
Last updated
04/01/2021
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