Individual
MR. DEREK LAMONT COUSINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
600 GRESHAM DR, NORFOLK, VA 23507-1904
(757) 466-0089
(757) 466-8017
Mailing address
6275 E VIRGINIA BEACH BLVD STE 300, NORFOLK, VA 23502-2851
(757) 466-0089
(757) 466-8017
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110010167
VA
Other
Enumeration date
01/10/2024
Last updated
07/24/2024
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