MEDICARE: MS. DARLA K KREIS MSN-RN, FNP-BC

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	363L00000X	Nurse Practitioner	71002070	IN
2	363L00000X	Nurse Practitioner	26019	SC

General Provider Information

NPI Number	:	1275579963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DARLA K KREIS MSN-RN, FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 751649
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1649
Country	:	US
Telephone Number	:	843-789-1620
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 BISHOP GADSDEN WAY STE 97
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-3506
Country	:	US
Telephone Number	:	843-724-2450
Fax Number	:

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	12/07/2022

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