Healthcare Provider Details

I. General information

NPI: 1801464029
Provider Name (Legal Business Name): DARIAN WILLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 06/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 CHARLOTTE HWY
ASHEVILLE NC
28803-9673
US

IV. Provider business mailing address

300 S SKYLOFT DR APT 204
ASHEVILLE NC
28801-0104
US

V. Phone/Fax

Practice location:
  • Phone: 828-414-2368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: