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General NPI Number Information
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NPI Number | 1629776984
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Entity Type | Individual
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Provider Name | JENNIFER DURHAM DNP-AGPCNP
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Gender | Female
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Dates
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Enumeration Date | 02/16/2023
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 158 EXECUTIVE DR
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City | DANVILLE
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State | VA
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Zip | 24541-4100
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Country | US
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Telephone | 434-791-1088
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Fax |
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Provider Business Mailing Address
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Address Line | 405 THOMPSON ST
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City | EDEN
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State | NC
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Zip | 27288-5045
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Country | US
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Telephone | 336-627-4896
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 256042
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 0024188273
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 0024188273
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License Number State | VA
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