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General NPI Number Information
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NPI Number | 1720865678
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Entity Type | Individual
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Provider Name | DEREK KONNEY
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Gender | Male
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Dates
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Enumeration Date | 09/13/2023
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | CARRETERA #2,KM,80.4 BARRIO SAN DANIEL
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City | SECTOR LAS CANELAS,ARECIBO
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State | PR
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Zip | 00614-4050
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Country | US
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Telephone | 787-878-5475
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Fax |
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Provider Business Mailing Address
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Address Line | 2225 TRELIPE DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-2341
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Country | US
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Telephone | 254-245-3633
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APRN11032724
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License Number State | FL
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