Healthcare Provider Details

I. General information

NPI: 1861060600
Provider Name (Legal Business Name): DEREK HUFFMAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 TURNER DR STE F
REIDSVILLE NC
27320-5754
US

IV. Provider business mailing address

217 TURNER DR STE F
REIDSVILLE NC
27320-5754
US

V. Phone/Fax

Practice location:
  • Phone: 336-342-6060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5017163
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: