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General NPI Number Information
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NPI Number | 1619884160
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Entity Type | Individual
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Provider Name | MADYSON ALEXIS DARR PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/27/2026
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Last Update Date | 08/27/2026
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Provider Practice Location Address
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Address Line | 400 N PLEASANT AVE
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City | CENTRALIA
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State | IL
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Zip | 62801-3056
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Country | US
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Telephone | 618-436-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 108 S CARBON ST APT B
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City | MARION
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State | IL
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Zip | 62959-1391
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Country | US
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Telephone | 618-663-7668
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | IL
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