Provider Demographics
NPI:1508216599
Name:TADDEO, DARCY (PA-C)
Entity type:Individual
Prefix:
First Name:DARCY
Middle Name:
Last Name:TADDEO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DARCY
Other - Middle Name:
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7835
Mailing Address - Fax:859-263-8808
Practice Address - Street 1:3470 BLAZER PKWY STE 150
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1078
Practice Address - Country:US
Practice Address - Phone:859-263-8807
Practice Address - Fax:859-263-8808
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7990363A00000X
NDPAC0778363A00000X
KYPA2707363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical