Provider Demographics
NPI:1144209495
Name:DARDEN, MARY WALLACE (APN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:WALLACE
Last Name:DARDEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 440100
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0100
Mailing Address - Country:US
Mailing Address - Phone:615-329-0570
Mailing Address - Fax:615-320-7091
Practice Address - Street 1:300 20TH AVE N
Practice Address - Street 2:SUITE 301
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2131
Practice Address - Country:US
Practice Address - Phone:615-329-0570
Practice Address - Fax:615-320-7091
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6544363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3904424Medicare UPIN