Provider Demographics
NPI:1306623350
Name:WADE, DARBY RAYBOURN (FNP)
Entity type:Individual
Prefix:
First Name:DARBY
Middle Name:RAYBOURN
Last Name:WADE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DARBY
Other - Middle Name:O'GEIL
Other - Last Name:RAYBOURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 CUMBERLAND RDG
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-4208
Mailing Address - Country:US
Mailing Address - Phone:228-224-3489
Mailing Address - Fax:
Practice Address - Street 1:501 DENIM WAY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-8664
Practice Address - Country:US
Practice Address - Phone:228-224-3489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906108363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily