MEDICARE: BULAH FAY DARNELL APN

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	363LF0000X	Family Nurse Practitioner	A01013	AR
2	363LF0000X	Family Nurse Practitioner	APO2413	LA

General Provider Information

NPI Number	:	1881677797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BULAH FAY DARNELL APN

Provider Business Mailing Address
First Line	:	706 ROSS ST
Second Line	:
City	:	OAK GROVE
State	:	LA
Zip	:	71263-9798
Country	:	US
Telephone Number	:	318-428-6134
Fax Number	:	318-428-7165

Provider Business Practice Location Address
First Line	:	2263 HWY 65 N
Second Line	:
City	:	MARSHALL
State	:	AR
Zip	:	72650-1060
Country	:	US
Telephone Number	:	870-448-5733
Fax Number	:	870-448-3392

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	08/12/2016

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