Provider Demographics
NPI:1669483624
Name:DARDEN, KIMBERLY (PA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:DARDEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7717 E 29TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-3443
Mailing Address - Country:US
Mailing Address - Phone:316-712-4970
Mailing Address - Fax:316-462-0661
Practice Address - Street 1:7717 E 29TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-3443
Practice Address - Country:US
Practice Address - Phone:316-712-4970
Practice Address - Fax:316-462-0661
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00758363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS116589OtherBCBS
KS9469OtherPHS
KS100387730AMedicaid
KS203456OtherHPK
KS9469OtherPHS
KS116589Medicare ID - Type Unspecified