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NPI Code Detail

MEDICARE: DIRK ANDREW DEKERLEGAND P.A.C.

MEDICARE: DIRK ANDREW DEKERLEGAND P.A.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
1363A00000XPhysician AssistantPA00642TX
2363LP0808XPsychiatric/Mental Health Nurse PractitionerPA00642TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679503965
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIRK ANDREW DEKERLEGAND P.A.C.
Provider Business Mailing Address
First Line : 4101 S MEDFORD DR
Second Line :
City : LUFKIN
State : TX
Zip : 75901-5633
Country : US
Telephone Number : 936-633-5650
Fax Number : 936-633-5695
Provider Business Practice Location Address
First Line : 4103 S MEDFORD DR
Second Line :
City : LUFKIN
State : TX
Zip : 75901-5633
Country : US
Telephone Number : 936-639-2384
Fax Number : 936-639-9888
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2006
Last Update Date : 04/29/2025

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Directions to “ DIRK ANDREW DEKERLEGAND P.A.C.” Practice Location

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