Provider Demographics
NPI:1164121588
Name:THE FUNCTIONAL FAMILY PRIMARY CARE
Entity Type:Organization
Organization Name:THE FUNCTIONAL FAMILY PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-316-0137
Mailing Address - Street 1:920 FREDERICA ST STE 104
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-3076
Mailing Address - Country:US
Mailing Address - Phone:270-238-6468
Mailing Address - Fax:866-248-7894
Practice Address - Street 1:920 FREDERICA ST STE 104
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-3076
Practice Address - Country:US
Practice Address - Phone:270-238-6468
Practice Address - Fax:866-248-7894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-24
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty