=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821854068
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUSSELL THOMAS DURDEN MSN, APRN, AGACNP-BC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2024
-----------------------------------------------------
Last Update Date | 12/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 257 MCDOWELL ST
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28803-2606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-258-1121
-----------------------------------------------------
Fax | 828-252-6114
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 238 WILDERNESS WAY
-----------------------------------------------------
City | BLAIRSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30512-5062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-309-9206
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN209339
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN209339
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 5020173
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------