Provider Demographics
NPI:1578183679
Name:DARKOW, KAYLA RANDALL (PA-C)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RANDALL
Last Name:DARKOW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4858 GADDYS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NC
Mailing Address - Zip Code:28128-7739
Mailing Address - Country:US
Mailing Address - Phone:704-985-5704
Mailing Address - Fax:
Practice Address - Street 1:548 SANDHURST DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4426
Practice Address - Country:US
Practice Address - Phone:910-484-3400
Practice Address - Fax:910-484-3404
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program