Healthcare Provider Details

I. General information

NPI: 1235771874
Provider Name (Legal Business Name): DEREK ANTHONY HARPOLE NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 W GREEN OAKS BLVD STE 750
ARLINGTON TX
76016-2728
US

IV. Provider business mailing address

3825 W GREEN OAKS BLVD STE 750
ARLINGTON TX
76016-2728
US

V. Phone/Fax

Practice location:
  • Phone: 210-840-7527
  • Fax: 817-389-6172
Mailing address:
  • Phone: 210-840-7527
  • Fax: 817-389-6172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201911388NP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP143503
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: