Provider Demographics
NPI:1669341855
Name:BATIESTE, DEREK R
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:R
Last Name:BATIESTE
Suffix:
Gender:M
Credentials:
Other - Prefix:MRS
Other - First Name:RAMONA
Other - Middle Name:K
Other - Last Name:BATIESTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 N SUNFLOWER RD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-8211
Mailing Address - Country:US
Mailing Address - Phone:601-334-4204
Mailing Address - Fax:
Practice Address - Street 1:22 N SUNFLOWER RD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-8211
Practice Address - Country:US
Practice Address - Phone:601-334-4204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-04
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver