MEDICARE: KELLY DARDEN MSN ANP-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	363LA2200X	Adult Health Nurse Practitioner	679092	TX
2	363LA2200X	Adult Health Nurse Practitioner	AP121656	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629342951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY DARDEN MSN ANP-BC

Provider Business Mailing Address
First Line	:	2929 CALDER ST
Second Line	:	SUITE 100
City	:	BEAUMONT
State	:	TX
Zip	:	77702-1845
Country	:	US
Telephone Number	:	409-833-9797
Fax Number	:	409-654-6886

Provider Business Practice Location Address
First Line	:	2010 DOWLEN RD
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77706-2525
Country	:	US
Telephone Number	:	409-833-9797
Fax Number	:	409-654-6918

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

Provider Enumeration Date	:	03/05/2012
Last Update Date	:	09/11/2018

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