MEDICARE: DEREK T TERRELL PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	405612	NY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ14940700	NJ
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN2326087	MA

General Provider Information

NPI Number	:	1841522398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK T TERRELL PMHNP-BC

Provider Business Mailing Address
First Line	:	6 MAIN STREET EXT UNIT 3560
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02361-7028
Country	:	US
Telephone Number	:	617-792-6144
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 FREEMAN DR
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-6887
Country	:	US
Telephone Number	:	617-792-6144
Fax Number	:

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

Provider Enumeration Date	:	02/09/2010
Last Update Date	:	01/31/2024

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