Provider Demographics
NPI:1952406274
Name:BOST, DEREK EDWARD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:EDWARD
Last Name:BOST
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:321 MULBERRY ST SW
Mailing Address - Street 2:PO BOX 1890
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5720
Mailing Address - Country:US
Mailing Address - Phone:828-757-5504
Mailing Address - Fax:828-757-5939
Practice Address - Street 1:321 MULBERRY ST SW
Practice Address - Street 2:CALDWELL ACUTE CARE SPECIALISTS
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5720
Practice Address - Country:US
Practice Address - Phone:828-757-5504
Practice Address - Fax:828-757-5939
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC103536363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
2756462AMedicare ID - Type Unspecified
P67793Medicare UPIN