MEDICARE: MRS. KEELY DARNELL WHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	NP248505	GA

General Provider Information

NPI Number	:	1144782749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KEELY DARNELL WHNP

Provider Business Mailing Address
First Line	:	133 SAMARITAN DR STE 306
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-2396
Country	:	US
Telephone Number	:	770-889-8302
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 SAMARITAN DR STE 306
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-2396
Country	:	US
Telephone Number	:	770-889-8302
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	12/11/2025

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