Provider Demographics
NPI:1215406293
Name:DERR, JULIAN K (CRNP)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:K
Last Name:DERR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JULIAN
Other - Middle Name:
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 448
Mailing Address - Street 2:
Mailing Address - City:EAST PETERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17520-0448
Mailing Address - Country:US
Mailing Address - Phone:717-391-7092
Mailing Address - Fax:717-735-2069
Practice Address - Street 1:2605 KEISER BLVD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3338
Practice Address - Country:US
Practice Address - Phone:610-685-8500
Practice Address - Fax:610-685-4833
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019006363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health