Provider Demographics
NPI:1760412795
Name:HIRST, DARLENE R (PA)
Entity Type:Individual
Prefix:MISS
First Name:DARLENE
Middle Name:R
Last Name:HIRST
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:DARLENE
Other - Middle Name:R
Other - Last Name:VAN DIERENDONK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:800 RAVEN HILL DR.
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002
Mailing Address - Country:US
Mailing Address - Phone:913-367-2131
Mailing Address - Fax:913-674-2023
Practice Address - Street 1:800 RAVENHILL DR
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-9204
Practice Address - Country:US
Practice Address - Phone:913-367-2131
Practice Address - Fax:913-674-2023
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005022719363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS763000013Medicare PIN
P26480Medicare UPIN
000097306Medicare PIN