Individual
DERRIYAN LANAE PRICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
5502 MARVIN SHIELDS BLVD, BLDG 472, GULFPORT, MS 39501
(228) 822-5061
Mailing address
5502 MARVIN SHIELDS BLVD,, BLDG 472, GULFPORT, MS 39501
(228) 822-5061
(228) 871-3390
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
207Q00000X
Family Medicine Physician
Primary
0102208259
VA
390200000X
Student in an Organized Health Care Education/Training Program
0102208259
VA
Other
Enumeration date
06/03/2022
Last updated
07/23/2025
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