Provider Demographics
NPI:1699433193
Name:BOARDEN, DARRELL FREDRICK (RRT)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:FREDRICK
Last Name:BOARDEN
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:103 SPRING CREEK CV
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-5177
Mailing Address - Country:US
Mailing Address - Phone:601-506-4958
Mailing Address - Fax:
Practice Address - Street 1:5903 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-3700
Practice Address - Country:US
Practice Address - Phone:601-899-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSRCP-1922227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered