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General NPI Number Information
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NPI Number | 1184943870
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Entity Type | Individual
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Provider Name | KIMBERLY K DURHAM CRNA
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Gender | Female
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Dates
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Enumeration Date | 05/20/2010
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Last Update Date | 05/20/2010
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Provider Practice Location Address
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Address Line | 1040 GULF BREEZE PKWY STE 100
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City | GULF BREEZE
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State | FL
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Zip | 32561-7809
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Country | US
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Telephone | 850-916-8500
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Fax | 850-916-8509
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Provider Business Mailing Address
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Address Line | 6831 HALCYON PARK DR
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City | MONTGOMERY
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State | AL
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Zip | 36117-6972
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Country | US
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Telephone | 334-396-6930
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Fax | 334-396-6929
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN3216652
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | ARNP
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License Number State | FL
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