Basic Information
| Provider Information | |||||||||
| NPI: | 1033286232 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURBIN | ||||||||
| FirstName: | JODI | ||||||||
| MiddleName: | CECILE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 830 S LIMESTONE ST | ||||||||
| Address2: | UKHC UNIVERSITY HEALTH SERVICE | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593235823 | ||||||||
| FaxNumber: | 8593231119 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 S LIMESTONE ST | ||||||||
| Address2: | UKHC UNIVERSITY HEALTH SERVICE | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593235823 | ||||||||
| FaxNumber: | 8593231119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 06/24/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3005063 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 3005063 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 000000517350 | 01 | KY | BCBS-BSMC | OTHER | 000000507077 | 01 | KY | BCBS-EBMC | OTHER | 000000517351 | 01 | KY | BCBS-MMC | OTHER | 000000507077 | 01 | KY | BCBS-AMC | OTHER | 7100003030 | 05 | KY | MEDICAID |