Provider Demographics
NPI:1447993597
Name:VINES, DARIAN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:DARIAN
Middle Name:
Last Name:VINES
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 WALNUTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-9753
Mailing Address - Country:US
Mailing Address - Phone:304-993-7795
Mailing Address - Fax:
Practice Address - Street 1:129 WALNUTVIEW DR
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813-9753
Practice Address - Country:US
Practice Address - Phone:304-993-7795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-17
Last Update Date:2022-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant