Provider Demographics
NPI:1235771874
Name:HARPOLE, DEREK ANTHONY (NP-C)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:ANTHONY
Last Name:HARPOLE
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 W GREEN OAKS BLVD STE 750
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2728
Mailing Address - Country:US
Mailing Address - Phone:210-840-7527
Mailing Address - Fax:817-389-6172
Practice Address - Street 1:3825 W GREEN OAKS BLVD STE 750
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-2728
Practice Address - Country:US
Practice Address - Phone:210-840-7527
Practice Address - Fax:817-389-6172
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201911388NP-PP363LF0000X
TXAP143503363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500776215Medicaid