Healthcare Provider Details

I. General information

NPI: 1881677797
Provider Name (Legal Business Name): BULAH FAY DARNELL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2263 HWY 65 N
MARSHALL AR
72650-1060
US

IV. Provider business mailing address

706 ROSS ST
OAK GROVE LA
71263-9798
US

V. Phone/Fax

Practice location:
  • Phone: 870-448-5733
  • Fax: 870-448-3392
Mailing address:
  • Phone: 318-428-6134
  • Fax: 318-428-7165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA01013
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPO2413
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: