Provider Demographics
NPI:1871517839
Name:ALLRED, DARRELL KEVIN (PA)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:KEVIN
Last Name:ALLRED
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 85378
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5378
Mailing Address - Country:US
Mailing Address - Phone:336-274-6682
Mailing Address - Fax:336-274-8097
Practice Address - Street 1:1331 N ELM ST STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6304
Practice Address - Country:US
Practice Address - Phone:336-274-6682
Practice Address - Fax:336-274-8097
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2025-10-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC101530363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP25015Medicare UPIN
NC2753097Medicare PIN