Provider Demographics
NPI:1073281069
Name:DURRETT, VIRGINIA (NP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:DURRETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GENA
Other - Middle Name:
Other - Last Name:DURRETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:3397 ROSEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-2306
Mailing Address - Country:US
Mailing Address - Phone:928-897-8743
Mailing Address - Fax:
Practice Address - Street 1:3397 ROSEWOOD ST
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-2306
Practice Address - Country:US
Practice Address - Phone:928-897-8743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ263306363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology