Provider Demographics
NPI:1427684562
Name:REEDY, DERICK STEVEN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DERICK
Middle Name:STEVEN
Last Name:REEDY
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11708 NICKELSVILLE HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:NICKELSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24271-2872
Mailing Address - Country:US
Mailing Address - Phone:276-258-1880
Mailing Address - Fax:276-258-0616
Practice Address - Street 1:11708 NICKELSVILLE HWY STE 2
Practice Address - Street 2:
Practice Address - City:NICKELSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24271-2872
Practice Address - Country:US
Practice Address - Phone:276-248-1880
Practice Address - Fax:276-258-0616
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN210678163WP0808X
KY3014893363LP0808X
TN27352363LP0808X
VA0024181231363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health