Provider Demographics
NPI:1346861986
Name:ARMITAGE, DEREK WILLIAM (RN)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:WILLIAM
Last Name:ARMITAGE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 DAVIS LN
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:TN
Mailing Address - Zip Code:37353-5119
Mailing Address - Country:US
Mailing Address - Phone:423-762-9161
Mailing Address - Fax:
Practice Address - Street 1:2200 MORRIS HILL RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2818
Practice Address - Country:US
Practice Address - Phone:423-499-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN186537163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent