Provider Demographics
NPI:1689602096
Name:MOURNING, DARREL J (ARNP)
Entity Type:Individual
Prefix:MR
First Name:DARREL
Middle Name:J
Last Name:MOURNING
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:231 MICHELLE DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:KS
Mailing Address - Zip Code:67026-9490
Mailing Address - Country:US
Mailing Address - Phone:620-584-2985
Mailing Address - Fax:
Practice Address - Street 1:5500 E KELLOGG DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1607
Practice Address - Country:US
Practice Address - Phone:316-651-3621
Practice Address - Fax:316-634-3091
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-36933-031363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health