Individual
MR. KEITH HURST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RNFA
Contact information
Practice address
9 PARK PL, SWANSEA, IL 62226-2967
(618) 233-5722
(618) 233-7069
Mailing address
9 PARK PL, SWANSEA, IL 62226-2967
(618) 233-5722
(618) 233-7069
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
041283029
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041283029
ILLINOIS STATE LICENSE
IL
01
—
H62351770285
DRIVER'S LICENSE
IL
Enumeration date
11/24/2009
Last updated
11/24/2009
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