Provider Demographics
NPI:1538372792
Name:GOWAN, DARLA J (NP)
Entity type:Individual
Prefix:
First Name:DARLA
Middle Name:J
Last Name:GOWAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DARLA
Other - Middle Name:J
Other - Last Name:BLACKBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6105 ASPEN GROVE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1341
Mailing Address - Country:US
Mailing Address - Phone:317-850-1492
Mailing Address - Fax:
Practice Address - Street 1:107 PARK PLACE BLVD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7151
Practice Address - Country:US
Practice Address - Phone:317-272-0708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001490A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201026160Medicaid
IN232230RRMedicare UPIN
IN201026160Medicaid