Healthcare Provider Details

I. General information

NPI: 1780649632
Provider Name (Legal Business Name): PATRICIA DURHAM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 JOLIET AVE UNIT 220
LUBBOCK TX
79415-1158
US

IV. Provider business mailing address

5219 CITY BANK PKWY STE 214
LUBBOCK TX
79407-3537
US

V. Phone/Fax

Practice location:
  • Phone: 806-761-0566
  • Fax: 806-744-7252
Mailing address:
  • Phone: 806-761-0333
  • Fax: 806-782-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number525228
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP110323
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: