Provider Demographics
NPI:1063985521
Name:FREE, DEREK ROBERT (ACNPC-AG, CNP)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:ROBERT
Last Name:FREE
Suffix:
Gender:M
Credentials:ACNPC-AG, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 KEMPSVILLE RD STE 212
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3927
Mailing Address - Country:US
Mailing Address - Phone:757-261-5977
Mailing Address - Fax:757-275-9913
Practice Address - Street 1:844 KEMPSVILLE RD STE 212
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3927
Practice Address - Country:US
Practice Address - Phone:757-261-5977
Practice Address - Fax:757-275-9913
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011226363L00000X
OHCNP.026029363LA2100X
VA0024176978363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5011226OtherNC PRESCRIBER ID
MF5051317OtherDEA