Healthcare Provider Details

I. General information

NPI: 1174456859
Provider Name (Legal Business Name): JOHN LUKE DARITY FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S NATIONAL AVE
SPRINGFIELD MO
65807-5210
US

IV. Provider business mailing address

779 W BROOKSHIRE DR
SPRINGFIELD MO
65810-1604
US

V. Phone/Fax

Practice location:
  • Phone: 314-707-1611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026024222
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: