Provider Demographics
NPI:1861363822
Name:URSERY, DARRYL STEPHEN JR
Entity type:Individual
Prefix:
First Name:DARRYL
Middle Name:STEPHEN
Last Name:URSERY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 W CHARLESTON BLVD STE 11
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1354
Mailing Address - Country:US
Mailing Address - Phone:775-421-7880
Mailing Address - Fax:
Practice Address - Street 1:5650 W CHARLESTON BLVD STE 11
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1354
Practice Address - Country:US
Practice Address - Phone:775-421-7880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty