Provider Demographics
NPI:1245320811
Name:FLUDD, DARLENE ARNETTE (FNP)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:ARNETTE
Last Name:FLUDD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:MC CLELLANVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29458-0608
Mailing Address - Country:US
Mailing Address - Phone:843-887-3274
Mailing Address - Fax:843-887-3817
Practice Address - Street 1:2482 POWELL RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-8590
Practice Address - Country:US
Practice Address - Phone:843-887-3274
Practice Address - Fax:843-887-3817
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 2523363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1182Medicaid
SCAPN-2523OtherADV.PRACTICE RN