Provider Demographics
NPI:1881677797
Name:DARNELL, BULAH FAY (APN)
Entity Type:Individual
Prefix:
First Name:BULAH
Middle Name:FAY
Last Name:DARNELL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 ROSS ST
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-9798
Mailing Address - Country:US
Mailing Address - Phone:318-428-6134
Mailing Address - Fax:318-428-7165
Practice Address - Street 1:2263 HWY 65 N
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:AR
Practice Address - Zip Code:72650-1060
Practice Address - Country:US
Practice Address - Phone:870-448-5733
Practice Address - Fax:870-448-3392
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01013363LF0000X
LAAPO2413363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily