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General NPI Number Information
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NPI Number | 1710721246
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Entity Type | Individual
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Provider Name | DERION HUBBARD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2024
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 815 N WACO AVE STE 35
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City | WICHITA
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State | KS
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Zip | 67203-3928
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Country | US
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Telephone | 316-290-9046
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 S OLIVER ST APT 509
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City | WICHITA
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State | KS
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Zip | 67210-1230
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Country | US
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Telephone | 316-347-3757
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State | KS
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