Provider Demographics
NPI:1093889081
Name:DURHAM, ANN HOAGLAND (CRNA ARNP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:HOAGLAND
Last Name:DURHAM
Suffix:
Gender:F
Credentials:CRNA ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:1489 TUCKER RD.
Mailing Address - City:GREENSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:42743-0162
Mailing Address - Country:US
Mailing Address - Phone:270-734-5585
Mailing Address - Fax:270-932-4157
Practice Address - Street 1:1489 TUCKER RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-9284
Practice Address - Country:US
Practice Address - Phone:270-734-5585
Practice Address - Fax:270-932-4157
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1035636163W00000X
OH194268163W00000X
KY662A367500000X
OH04296367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74662008Medicaid
KYR95499Medicare UPIN
KY00652023Medicare PIN
KY74662008Medicaid
KYK138001Medicare PIN