Provider Demographics
NPI:1780216721
Name:DURHAM, JAMIE (APRN)
Entity type:Individual
Prefix:
First Name:JAMIE
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 1:2900 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-6113
Mailing Address - Country:US
Mailing Address - Phone:270-238-6468
Mailing Address - Fax:
Practice Address - Street 1:2900 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6113
Practice Address - Country:US
Practice Address - Phone:270-238-6468
Practice Address - Fax:844-374-0233
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100649890Medicaid