Doctor Name: | SHELLY WARREN DARTY |
NPI Number: | 1013990712 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PAC |
License Number: | 102585 |
Business Practice Address: | 861 Old Winston Rd Kernersville, NC - 272847140 |
Business Phone Number: | 3368022300 |
Business Fax Number: | 3368022301 |
Mailing Address: | 607 Idol St, HIGH POINT |
State: | NC |
Postal Code: | 272627804 |
Phone Number: | 3368022400 |
Fax Number: | 3368022001 |
NPI Enumeration Date: | 11/28/2005 |
NPI Last Update Date: | 05/18/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 102585 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |