Provider Demographics
NPI:1215184635
Name:ALLAN, DARLA JOE (NP-C)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:JOE
Last Name:ALLAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:DARLA
Other - Middle Name:
Other - Last Name:SPAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 955860
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-3052
Mailing Address - Country:US
Mailing Address - Phone:636-498-5944
Mailing Address - Fax:
Practice Address - Street 1:501 DU QUOIN ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812
Practice Address - Country:US
Practice Address - Phone:618-435-5362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003016544207P00000X
MOF0608448363L00000X
IL209017245363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1215184635Medicaid
IL209017245OtherLICENSE
MO132100012Medicare PIN