Individual
MR. FRED THOMAS HURST JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
68 REDFERN TRL, PETAL, MS 39465-9415
(601) 310-6813
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
2023035281
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
861818
IN
367500000X
Certified Registered Nurse Anesthetist
R861818
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00122661
—
MS
05
—
1517906
—
TN
01
—
4244301
BLUE CROSS BLUE SHIELD OF TN
TN
05
—
PENDING
—
WV
Enumeration date
05/27/2006
Last updated
05/23/2025
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