Provider Demographics
NPI:1144579400
Name:DARBY-MCLAURIN, MARY D (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:D
Last Name:DARBY-MCLAURIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 KIMBERLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-2184
Mailing Address - Country:US
Mailing Address - Phone:601-344-7801
Mailing Address - Fax:601-342-2766
Practice Address - Street 1:39 KIMBERLEY DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-2184
Practice Address - Country:US
Practice Address - Phone:601-344-7801
Practice Address - Fax:601-342-2766
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X, 261QA0600X
MSR875079163WA2000X, 163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice
No376J00000XNursing Service Related ProvidersHomemaker
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08137540Medicaid