1184943870 NPI number — KIMBERLY K DURHAM CRNA

Table of content: KIMBERLY K DURHAM CRNA (NPI 1184943870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184943870 NPI number — KIMBERLY K DURHAM CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DURHAM
Provider First Name:
KIMBERLY
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184943870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6831 HALCYON PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36117-6972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-396-6930
Provider Business Mailing Address Fax Number:
334-396-6929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 GULF BREEZE PKWY
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
GULF BREEZE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32561-7809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-916-8500
Provider Business Practice Location Address Fax Number:
850-916-8509
Provider Enumeration Date:
05/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN3216652 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: ARNP , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: EMT87949 . This is a "EMT LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ARNP3216652 . This is a "ARNP LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: PMD200872 . This is a "PARAMEDIC LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: RN3216652 . This is a "RN LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com