Provider Demographics
NPI:1013665645
Name:FRIERSON, DERRICK EDMOND
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:EDMOND
Last Name:FRIERSON
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 1:750 DERBY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45232-1816
Mailing Address - Country:US
Mailing Address - Phone:513-213-3679
Mailing Address - Fax:
Practice Address - Street 1:750 DERBY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45232-1816
Practice Address - Country:US
Practice Address - Phone:513-213-3679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator