Healthcare Provider Details

I. General information

NPI: 1184002776
Provider Name (Legal Business Name): JON DURKIN BC-HIS, ACA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2134 NICHOLASVILLE RD SUITE 1
LEXINGTON KY
40503-2521
US

IV. Provider business mailing address

2134 NICHOLASVILLE RD SUITE
LEXINGTON KY
40503-2521
US

V. Phone/Fax

Practice location:
  • Phone: 859-276-3277
  • Fax:
Mailing address:
  • Phone: 859-276-3277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number140
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: