=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306504972
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA DURHAM FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2021
-----------------------------------------------------
Last Update Date | 10/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 E 2ND ST
-----------------------------------------------------
City | DEFIANCE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43512-9905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-783-3273
-----------------------------------------------------
Fax | 419-783-2799
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 319 BROWNELL AVE
-----------------------------------------------------
City | NAPOLEON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43545-2128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-966-4645
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.0030385
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------