Healthcare Provider Details

I. General information

NPI: 1255169629
Provider Name (Legal Business Name): DARRELL BOYKIN BAILEY FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 DIVISADERO ST STE 120
SAN FRANCISCO CA
94115-3011
US

IV. Provider business mailing address

795 8TH AVE APT 301
SAN FRANCISCO CA
94118-3769
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-4444
  • Fax:
Mailing address:
  • Phone: 205-266-3007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95030388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: