Williams, Derrick Lane

Williams, Derrick Lane is an sole proprietor health care provider with primary practice located at 7950 W Jefferson Blvd , Fort Wayne IN 46804-4140. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Acute Care, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is his primary health care specialty. Williams, Derrick Lane can be contacted via phone (260) 203-9600.

Contact Information

Primary practice address
7950 W Jefferson Blvd Fort Wayne IN 46804-4140
Phone: (260) 203-9600
Fax: (260) 739-6167
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 28139511A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 71003104A Indiana

Profile Details

NPI number 1922333194
LBN Legal business name Williams, Derrick Lane
Credentials RN, APRN, ACNP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 6th, 2009
Last updated Sep 2nd, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922333194 NPPES
Indiana MEDICAID 200972030

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