Provider Demographics
NPI:1619524733
Name:DURHAM, MICHELLE (APRN)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:DURHAM
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 1:4123 OLYMPIC BLVD STE 151
Mailing Address - Street 2:
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018-3508
Mailing Address - Country:US
Mailing Address - Phone:859-301-2999
Mailing Address - Fax:859-301-2984
Practice Address - Street 1:236 WENDEL H FORD BLVD
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-1272
Practice Address - Country:US
Practice Address - Phone:859-444-2871
Practice Address - Fax:859-817-8559
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010241363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health