Provider Demographics
NPI:1962704643
Name:DARDEN, JUDY FOX
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:FOX
Last Name:DARDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:101 WEST GREENE STREET
Mailing Address - City:SNOW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28580-0071
Mailing Address - Country:US
Mailing Address - Phone:252-747-2976
Mailing Address - Fax:252-747-7802
Practice Address - Street 1:101 W GREENE ST
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-1431
Practice Address - Country:US
Practice Address - Phone:252-747-2976
Practice Address - Fax:252-747-7802
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4249372600000X, 3747P1801X, 374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1053563650Medicaid