Provider Demographics
NPI:1952728636
Name:LOVE-JONES, DERRICK MICAH (NP)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:MICAH
Last Name:LOVE-JONES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:DERRICK
Other - Middle Name:MICAH
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1705 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-3222
Mailing Address - Country:US
Mailing Address - Phone:214-425-5935
Mailing Address - Fax:972-919-0425
Practice Address - Street 1:1705 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-3222
Practice Address - Country:US
Practice Address - Phone:214-425-5935
Practice Address - Fax:972-919-0425
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX786037363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care