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NPI Code Detail

MEDICARE: DERRELL D DELOACH FNP-C

MEDICARE:   DERRELL D DELOACH  FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner604578TX

General Provider Information

NPI Number : 1548284433
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERRELL D DELOACH FNP-C
Provider Business Mailing Address
First Line : 2701 S GEORGIA ST
Second Line :
City : AMARILLO
State : TX
Zip : 79109-1979
Country : US
Telephone Number : 806-350-3000
Fax Number : 806-467-9799
Provider Business Practice Location Address
First Line : 2701 S GEORGIA ST
Second Line :
City : AMARILLO
State : TX
Zip : 79109-1979
Country : US
Telephone Number : 806-350-3000
Fax Number : 806-350-3337
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 07/26/2021

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Directions to “ DERRELL D DELOACH FNP-C” Practice Location

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