Healthcare Provider Details

I. General information

NPI: 1396660213
Provider Name (Legal Business Name): DEREK WONG FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6354 WALKER LN STE 350
ALEXANDRIA VA
22310-3256
US

IV. Provider business mailing address

6354 WALKER LN STE 350
ALEXANDRIA VA
22310-3256
US

V. Phone/Fax

Practice location:
  • Phone: 703-722-6700
  • Fax:
Mailing address:
  • Phone: 703-722-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024198350
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: