Provider Demographics
NPI:1306623350
Name:WADE, DARBY RAYBOURN (FNP)
Entity type:Individual
Prefix:
First Name:DARBY
Middle Name:RAYBOURN
Last Name:WADE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DARBY
Other - Middle Name:O'GEIL
Other - Last Name:RAYBOURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:128 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:39218
Mailing Address - Country:US
Mailing Address - Phone:601-326-1960
Mailing Address - Fax:601-326-1706
Practice Address - Street 1:128 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218
Practice Address - Country:US
Practice Address - Phone:601-326-1960
Practice Address - Fax:601-326-1706
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906108363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily