Provider Demographics
NPI:1174413207
Name:SMITH, DERRICK ANDREA (LPN)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:ANDREA
Last Name:SMITH
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8891 W TURNBERRY PL APT 204
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2541
Mailing Address - Country:US
Mailing Address - Phone:901-724-3023
Mailing Address - Fax:
Practice Address - Street 1:3000 GETWELL RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-2205
Practice Address - Country:US
Practice Address - Phone:901-422-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN91683164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse