Provider Demographics
NPI:1538551254
Name:BEDWARD, DARCEY JO (FNP APNP)
Entity type:Individual
Prefix:
First Name:DARCEY
Middle Name:JO
Last Name:BEDWARD
Suffix:
Gender:F
Credentials:FNP APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 S AVON STORE RD
Mailing Address - Street 2:
Mailing Address - City:BRODHEAD
Mailing Address - State:WI
Mailing Address - Zip Code:53520-9328
Mailing Address - Country:US
Mailing Address - Phone:608-449-8207
Mailing Address - Fax:
Practice Address - Street 1:8325 S AVON STORE RD
Practice Address - Street 2:
Practice Address - City:BRODHEAD
Practice Address - State:WI
Practice Address - Zip Code:53520-9328
Practice Address - Country:US
Practice Address - Phone:608-449-8207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130017-030363L00000X
WI6296-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100043556Medicaid