Provider Demographics
NPI:1154723690
Name:ALBERT, DERINEKIA
Entity type:Individual
Prefix:
First Name:DERINEKIA
Middle Name:
Last Name:ALBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4652 GLEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70811-6023
Mailing Address - Country:US
Mailing Address - Phone:225-266-8956
Mailing Address - Fax:
Practice Address - Street 1:4667 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-1514
Practice Address - Country:US
Practice Address - Phone:225-266-8956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator