Individual
MR. DERRICK KIRK WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1161 E 300 N, PROVO, UT 84606-3539
(801) 852-4468
(801) 375-4045
Mailing address
750 NORTH 200 WEST SUITE 300, PROVO, UT 84601
(801) 373-4760
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/13/2011
Last updated
09/13/2011
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