Provider Demographics
NPI:1265929392
Name:DURHAM, JENNIFER NICOLE
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:NICOLE
Last Name:DURHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 N BIGHORN ST
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-3807
Mailing Address - Country:US
Mailing Address - Phone:918-913-5199
Mailing Address - Fax:
Practice Address - Street 1:307 N BIGHORN ST
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-3807
Practice Address - Country:US
Practice Address - Phone:918-913-5199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-14
Last Update Date:2018-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist