Provider Demographics
NPI:1568997914
Name:DURDEN, DEBRA (APRN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:DURDEN
Suffix:
Gender:F
Credentials:APRN
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 407
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-0407
Mailing Address - Country:US
Mailing Address - Phone:912-538-8105
Mailing Address - Fax:912-538-8109
Practice Address - Street 1:1811 EDWINA DR
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8963
Practice Address - Country:US
Practice Address - Phone:912-538-8105
Practice Address - Fax:912-538-8109
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN134608363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care