Healthcare Provider Details

I. General information

NPI: 1386986040
Provider Name (Legal Business Name): KATHERINE HUBER DURNEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 ASHLEY ST STE 303
BOWLING GREEN KY
42103-2451
US

IV. Provider business mailing address

1048 ASHLEY ST STE 303
BOWLING GREEN KY
42103-2451
US

V. Phone/Fax

Practice location:
  • Phone: 707-968-9602
  • Fax: 270-842-5683
Mailing address:
  • Phone: 270-796-8960
  • Fax: 270-842-5683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number52572
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number52572
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: