Provider Demographics
NPI:1477958049
Name:DERRICK, WILLIAM JR (FNP-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:DERRICK
Suffix:JR
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 TX-71 WEST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-4856
Mailing Address - Country:US
Mailing Address - Phone:512-332-2273
Mailing Address - Fax:512-308-9842
Practice Address - Street 1:717 TX-71 WEST
Practice Address - Street 2:SUITE 500
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602
Practice Address - Country:US
Practice Address - Phone:512-332-2273
Practice Address - Fax:512-308-9842
Is Sole Proprietor?:No
Enumeration Date:2014-10-25
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126699363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily