Provider Demographics
NPI:1235505827
Name:NEW, DARRELL I (APRN)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:
Last Name:NEW
Suffix:I
Gender:M
Credentials:APRN
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 636961
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6961
Mailing Address - Country:US
Mailing Address - Phone:513-981-5130
Mailing Address - Fax:513-981-5015
Practice Address - Street 1:1532 LONE OAK RD
Practice Address - Street 2:SUITE 150
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7940
Practice Address - Country:US
Practice Address - Phone:270-538-5596
Practice Address - Fax:270-538-5597
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009627363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily