Provider Demographics
NPI:1083017313
Name:DURHAM, LAUREN (CNP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:DURHAM
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 OLDE CASTLE LOOP
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-6013
Mailing Address - Country:US
Mailing Address - Phone:662-416-2386
Mailing Address - Fax:
Practice Address - Street 1:555 HIGHWAY 6 E
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-3003
Practice Address - Country:US
Practice Address - Phone:662-578-2030
Practice Address - Fax:662-578-2050
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000018882363LF0000X
MSR891374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily