Individual
DERRICK NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MHPP
Contact information
Practice address
1615 MLK BLVD, MALVERN, AR 72104-2233
(501) 332-5236
(501) 620-5109
Mailing address
125 DONS WAY, HOT SPRINGS, AR 71913-6478
(501) 624-7111
(501) 620-5109
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
138312726
—
AR
Enumeration date
02/02/2009
Last updated
02/02/2009
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