MEDICARE: KIRBIE DERICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1821740705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRBIE DERICK

Provider Business Mailing Address
First Line	:	500 N VALLEY PKWY STE 103
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-3479
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N VALLEY PKWY STE 103
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-3479
Country	:	US
Telephone Number	:	469-946-8400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2022
Last Update Date	:	12/19/2025

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Directions to “ KIRBIE DERICK ” Practice Location

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