Provider Demographics
NPI:1013616424
Name:TINGLER, DEREK SHANE
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:SHANE
Last Name:TINGLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 CLAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9405
Mailing Address - Country:US
Mailing Address - Phone:304-549-8540
Mailing Address - Fax:
Practice Address - Street 1:173 CLAYTON AVE
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9405
Practice Address - Country:US
Practice Address - Phone:304-549-8540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant