Healthcare Provider Details

I. General information

NPI: 1467247395
Provider Name (Legal Business Name): DERIK STEVEN PHILPOT APSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 W DIXIE ST
LONDON KY
40741-1939
US

IV. Provider business mailing address

241 MOORES CREEK RD
FOURMILE KY
40939-6201
US

V. Phone/Fax

Practice location:
  • Phone: 606-595-2186
  • Fax:
Mailing address:
  • Phone: 606-595-2186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: