MEDICARE: DARIAN VINES PHYSICIAN ASSISTANT

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1447993597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARIAN VINES PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	134 MEDICAL PL
Second Line	:
City	:	BEAVER
State	:	WV
Zip	:	25813-8977
Country	:	US
Telephone Number	:	304-255-1080
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 MEDICAL PL
Second Line	:
City	:	BEAVER
State	:	WV
Zip	:	25813-8977
Country	:	US
Telephone Number	:	304-255-1080
Fax Number	:

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

Provider Enumeration Date	:	04/17/2022
Last Update Date	:	12/23/2025

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