Provider Demographics
NPI:1184950487
Name:NASH, DERRICK SHAWN
Entity type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:SHAWN
Last Name:NASH
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 1:7868 OLD LEMAY FERRY RD
Mailing Address - Street 2:
Mailing Address - City:BARNHART
Mailing Address - State:MO
Mailing Address - Zip Code:63012-1728
Mailing Address - Country:US
Mailing Address - Phone:314-363-7960
Mailing Address - Fax:636-942-1021
Practice Address - Street 1:7868 OLD LEMAY FERRY RD
Practice Address - Street 2:
Practice Address - City:BARNHART
Practice Address - State:MO
Practice Address - Zip Code:63012-1728
Practice Address - Country:US
Practice Address - Phone:314-363-7960
Practice Address - Fax:636-942-1021
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier