Provider Demographics
NPI:1558752733
Name:DURHAM, EMILY SMITH (CRNA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:SMITH
Last Name:DURHAM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 HENNESSY BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-0319
Mailing Address - Country:US
Mailing Address - Phone:225-214-6438
Mailing Address - Fax:225-214-6437
Practice Address - Street 1:7777 HENNESSY BLVD STE 301
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-0319
Practice Address - Country:US
Practice Address - Phone:225-214-6438
Practice Address - Fax:225-214-6438
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127325367500000X
LAAP219455367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8070UKOtherBCBS
TX344639501Medicaid
TX344639501Medicaid