MEDICARE: MR. DEREK JASON TIMBS RN MSN FNP

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
1	207Q00000X	Family Medicine Physician	669983	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	813753	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609886910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEREK JASON TIMBS RN MSN FNP

Provider Business Mailing Address
First Line	:	13306 GREENWOOD LAKES LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-5484
Country	:	US
Telephone Number	:	346-432-5404
Fax Number	:	660-951-7793

Provider Business Practice Location Address
First Line	:	13306 GREENWOOD LAKES LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-5484
Country	:	US
Telephone Number	:	346-432-5404
Fax Number	:	660-951-7793

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	09/17/2024

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