Provider Demographics
NPI:1184943870
Name:DURHAM, KIMBERLY K (CRNA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
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 1:6831 HALCYON PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-6972
Mailing Address - Country:US
Mailing Address - Phone:334-396-6930
Mailing Address - Fax:334-396-6929
Practice Address - Street 1:1040 GULF BREEZE PKWY
Practice Address - Street 2:STE 100
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-7809
Practice Address - Country:US
Practice Address - Phone:850-916-8500
Practice Address - Fax:850-916-8509
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3216652163W00000X
FLARNP367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEMT87949OtherEMT LICENSE
FLARNP3216652OtherARNP LICENSE
FLPMD200872OtherPARAMEDIC LICENSE
FLRN3216652OtherRN LICENSE