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General NPI Number Information
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NPI Number | 1801292313
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Entity Type | Individual
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Provider Name | CARLY DURHAM FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 4710 BELLAIRE BLVD STE 340
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City | BELLAIRE
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State | TX
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Zip | 77401-4526
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Country | US
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Telephone | 713-860-1755
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Fax |
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Provider Business Mailing Address
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Address Line | 123 4TH ST
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City | SUGAR LAND
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State | TX
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Zip | 77498-2615
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Country | US
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Telephone | 281-978-0757
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP126710
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License Number State | TX
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