Provider Demographics
NPI:1699735209
Name:SCOTT, DARLA CRUISE (NP)
Entity type:Individual
Prefix:
First Name:DARLA
Middle Name:CRUISE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PROVIDER ENROLLMENT
Mailing Address - Street 2:100 KIMEL FOREST DRIVE
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-713-0947
Mailing Address - Fax:
Practice Address - Street 1:1038 BETHANIA RURAL HALL RD
Practice Address - Street 2:
Practice Address - City:RURAL HALL
Practice Address - State:NC
Practice Address - Zip Code:27045-9552
Practice Address - Country:US
Practice Address - Phone:367-169-2703
Practice Address - Fax:336-702-9313
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0002-00499363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005747Medicaid
NC7005747Medicaid
NCS83000Medicare UPIN