Provider Demographics
NPI:1164935839
Name:DURHAM, KATHARINE ANNE (RT R (ARRT))
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:ANNE
Last Name:DURHAM
Suffix:
Gender:F
Credentials:RT R (ARRT)
Other - Prefix:MS
Other - First Name:KATHARINE
Other - Middle Name:ANNE
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2920 BILLY JACK DR APT 1
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7486
Mailing Address - Country:US
Mailing Address - Phone:501-908-5692
Mailing Address - Fax:
Practice Address - Street 1:2302 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6297
Practice Address - Country:US
Practice Address - Phone:501-329-3831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5722792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology