Provider Demographics
NPI:1912676669
Name:LITTLEJOHN, DEREK MICHAEL (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:MICHAEL
Last Name:LITTLEJOHN
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9245 N. MERIDIAN STREET SUITE 300
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260
Mailing Address - Country:US
Mailing Address - Phone:317-818-9000
Mailing Address - Fax:317-818-9009
Practice Address - Street 1:9245 N. MERIDIAN STREET SUITE 300
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260
Practice Address - Country:US
Practice Address - Phone:317-818-9000
Practice Address - Fax:317-818-9009
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28220461A163WP0808X
IN71012926A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health