=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245320811
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARLENE ARNETTE FLUDD FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2006
-----------------------------------------------------
Last Update Date | 03/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2482 POWELL RD
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29440-8590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-887-3274
-----------------------------------------------------
Fax | 843-887-3817
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 608
-----------------------------------------------------
City | MC CLELLANVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29458-0608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-887-3274
-----------------------------------------------------
Fax | 843-887-3817
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APN 2523
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------