Provider Demographics
NPI:1760822969
Name:DEVONNA GILES DURHAM, APRN
Entity Type:Organization
Organization Name:DEVONNA GILES DURHAM, APRN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DEVONNA
Authorized Official - Middle Name:GILES
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:606-526-9664
Mailing Address - Street 1:513 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2411
Mailing Address - Country:US
Mailing Address - Phone:606-526-9664
Mailing Address - Fax:606-526-6263
Practice Address - Street 1:513 18TH ST
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2411
Practice Address - Country:US
Practice Address - Phone:606-526-9664
Practice Address - Fax:606-526-6263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003233261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center