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General NPI Number Information
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NPI Number | 1801228663
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Entity Type | Individual
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Provider Name | DEREK H HANCOCK APN
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Gender | Male
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Dates
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Enumeration Date | 08/04/2013
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 225 E JACKSON AVE
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City | JONESBORO
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State | AR
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Zip | 72401-3119
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Country | US
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Telephone | 870-207-1630
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Fax | 870-207-6581
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Provider Business Mailing Address
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Address Line | 6032 BEAVER CREEK LN
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City | JONESBORO
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State | AR
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Zip | 72404-9558
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Country | US
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Telephone | 501-412-4777
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A003900
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License Number State | AR
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