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General NPI Number Information
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NPI Number | 1598571077
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Entity Type | Individual
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Provider Name | CODY DURBIN
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Gender | Male
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 3040 DOLPHIN DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-7125
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Country | US
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Telephone | 270-737-4715
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 932958
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City | CLEVELAND
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State | OH
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Zip | 44193-0028
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Country | US
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Telephone |
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4025038
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4025038
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License Number State | KY
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