Individual
MILES DURHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
105 KEETON DR, HOPKINSVILLE, KY 42240-8756
(270) 889-0701
Mailing address
105 KEETON DR, HOPKINSVILLE, KY 42240-8756
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
KYPA495
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100434950
—
KY
Enumeration date
08/05/2016
Last updated
06/10/2020
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