Individual
DEREK STOCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1202 28TH ST S, FARGO, ND 58103-8700
(701) 280-9545
Mailing address
1202 28TH ST S, FARGO, ND 58103-8700
(701) 280-9545
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
174400000X
Specialist
—
—
247200000X
Other Technician
—
—
Other
Enumeration date
09/30/2024
Last updated
07/28/2026
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