Provider Demographics
NPI:1144556341
Name:DURHAM, JAPETH (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:JAPETH
Middle Name:
Last Name:DURHAM
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STONECREST BLVD STE 410
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6802
Mailing Address - Country:US
Mailing Address - Phone:615-220-6144
Mailing Address - Fax:615-220-3663
Practice Address - Street 1:300 STONECREST BLVD STE 410
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6802
Practice Address - Country:US
Practice Address - Phone:615-220-6144
Practice Address - Fax:615-220-3663
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN164106163WC0200X
TN14894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine