Provider Demographics
NPI:1134089329
Name:TIMMONS, DERRICK ANTHONY
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:ANTHONY
Last Name:TIMMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 FLORIDA AVE NE APT 205
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-7965
Mailing Address - Country:US
Mailing Address - Phone:202-883-2674
Mailing Address - Fax:
Practice Address - Street 1:400 FLORIDA AVE NE APT 205
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7965
Practice Address - Country:US
Practice Address - Phone:202-883-2674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3995866171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator