Healthcare Provider Details

I. General information

NPI: 1821854068
Provider Name (Legal Business Name): RUSSELL THOMAS DURDEN MSN, APRN, AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 MCDOWELL ST
ASHEVILLE NC
28803-2606
US

IV. Provider business mailing address

238 WILDERNESS WAY
BLAIRSVILLE GA
30512-5062
US

V. Phone/Fax

Practice location:
  • Phone: 828-258-1121
  • Fax: 828-252-6114
Mailing address:
  • Phone: 912-309-9206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number5020173
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN209339
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN209339
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: