Provider Demographics
NPI:1972793800
Name:DURFEE, KIERSA DIANE (MD)
Entity type:Individual
Prefix:
First Name:KIERSA
Middle Name:DIANE
Last Name:DURFEE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 N SAWYER RD
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-2572
Practice Address - Country:US
Practice Address - Phone:260-347-8030
Practice Address - Fax:260-347-8035
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072818A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48292OtherBLUE CROSS/BLUE SHIELD
FL000114200Medicaid
FL000114200Medicaid