Provider Demographics
NPI:1275883290
Name:DESPAIN, DARLA K (FNP)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:K
Last Name:DESPAIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2111 LEGEND COURT
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101
Mailing Address - Country:US
Mailing Address - Phone:573-581-2348
Mailing Address - Fax:573-581-9447
Practice Address - Street 1:2475 BROADWAY BLUFFS DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201
Practice Address - Country:US
Practice Address - Phone:573-777-9282
Practice Address - Fax:573-777-9569
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2012030915363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1275883290Medicaid