Provider Demographics
NPI:1477540045
Name:VALENTINE, DARRYL K (PA)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:K
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:235 SINGLETON RIDGE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9136
Mailing Address - Country:US
Mailing Address - Phone:843-347-2121
Mailing Address - Fax:843-347-5565
Practice Address - Street 1:235 SINGLETON RIDGE RD STE 103
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9136
Practice Address - Country:US
Practice Address - Phone:843-347-2121
Practice Address - Fax:843-347-5565
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2493363A00000X
GA003773363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant