Provider Demographics
NPI:1629342951
Name:DARDEN, KELLY (MSN ANP-BC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DARDEN
Suffix:
Gender:F
Credentials:MSN ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 CALDER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1845
Mailing Address - Country:US
Mailing Address - Phone:409-833-9797
Mailing Address - Fax:409-654-6886
Practice Address - Street 1:2010 DOWLEN RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-2525
Practice Address - Country:US
Practice Address - Phone:409-833-9797
Practice Address - Fax:409-654-6918
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX679092363LA2200X
TXAP121656363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX356068201Medicaid