Provider Demographics
NPI:1467247395
Name:PHILPOT, DERIK STEVEN (APSS)
Entity type:Individual
Prefix:
First Name:DERIK
Middle Name:STEVEN
Last Name:PHILPOT
Suffix:
Gender:
Credentials:APSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 MOORES CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FOURMILE
Mailing Address - State:KY
Mailing Address - Zip Code:40939-6201
Mailing Address - Country:US
Mailing Address - Phone:606-595-2186
Mailing Address - Fax:
Practice Address - Street 1:318 W DIXIE ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1939
Practice Address - Country:US
Practice Address - Phone:606-595-2186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261QM0850X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health