MEDICARE: LAUREN CANNON DURHAM CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN0000018882	TN
2	363LF0000X	Family Nurse Practitioner	R891374	MS
3	363L00000X	Nurse Practitioner	5024434	NC

General Provider Information

NPI Number	:	1083017313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN CANNON DURHAM CNP

Provider Business Mailing Address
First Line	:	229 OLDE CASTLE LOOP
Second Line	:
City	:	OXFORD
State	:	MS
Zip	:	38655-6013
Country	:	US
Telephone Number	:	662-416-2386
Fax Number	:

Provider Business Practice Location Address
First Line	:	5010 SOUTHPORT CROSSING WAY
Second Line	:
City	:	SOUTHPORT
State	:	NC
Zip	:	28461
Country	:	US
Telephone Number	:	910-721-5065
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2014
Last Update Date	:	06/04/2026

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