Provider Demographics
NPI:1548969173
Name:DURHAM, TALEYA (FNP)
Entity type:Individual
Prefix:
First Name:TALEYA
Middle Name:
Last Name:DURHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 W SUGAR CREEK RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-6103
Mailing Address - Country:US
Mailing Address - Phone:704-979-8210
Mailing Address - Fax:
Practice Address - Street 1:537 W SUGAR CREEK RD STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-6103
Practice Address - Country:US
Practice Address - Phone:704-979-8210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCDURH-9EWXF363LF0000X
NC5017767363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily