Provider Demographics
NPI:1871335679
Name:STITES, DARIN O'SHEA II (PA-C)
Entity type:Individual
Prefix:
First Name:DARIN
Middle Name:O'SHEA
Last Name:STITES
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 TANK TWO RD
Mailing Address - Street 2:
Mailing Address - City:RIDGELY
Mailing Address - State:TN
Mailing Address - Zip Code:38080-6201
Mailing Address - Country:US
Mailing Address - Phone:720-512-1046
Mailing Address - Fax:
Practice Address - Street 1:1760 TANK TWO RD
Practice Address - Street 2:
Practice Address - City:RIDGELY
Practice Address - State:TN
Practice Address - Zip Code:38080-6201
Practice Address - Country:US
Practice Address - Phone:720-512-1046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
TN6095363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical