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General NPI Number Information
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NPI Number | 1629665724
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Entity Type | Individual
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Provider Name | KEELI SUE DARST NP
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Gender | Female
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Dates
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Enumeration Date | 12/23/2020
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Last Update Date | 12/23/2020
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Provider Practice Location Address
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Address Line | 1009 S BROADWAY ST
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City | LA PORTE
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State | TX
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Zip | 77571-5327
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Country | US
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Telephone | 281-941-4174
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Fax | 281-941-4692
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Provider Business Mailing Address
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Address Line | 715 TIMBER COVE DR
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City | SEABROOK
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State | TX
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Zip | 77586-4615
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Country | US
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Telephone | 757-676-7315
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1010232
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License Number State | TX
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