| Doctor Name: | KELLY HURST |
| NPI Number: | 1023425493 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 07-1582-000-05 |
| Business Practice Address: | 25 Deltona Blvd Saint Augustine, FL - 320864203 |
| Business Phone Number: | 9047940268 |
| Business Fax Number: | |
| Mailing Address: | 25 Deltona Blvd, SAINT AUGUSTINE |
| State: | FL |
| Postal Code: | 320864203 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/17/2014 |
| NPI Last Update Date: | 07/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | 07-1582-000-05 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |