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NPI Code Detail

MEDICARE: KIRSTEN BAILEY DERICKS PA-C

MEDICARE: KIRSTEN BAILEY DERICKS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant

General Provider Information

NPI Number : 1689353930
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIRSTEN BAILEY DERICKS PA-C
Provider Business Mailing Address
First Line : 3211 GRANT LINE RD STE 15
Second Line :
City : NEW ALBANY
State : IN
Zip : 47150-2175
Country : US
Telephone Number : 812-221-1186
Fax Number : 949-882-0452
Provider Business Practice Location Address
First Line : 3211 GRANT LINE RD STE 15
Second Line :
City : NEW ALBANY
State : IN
Zip : 47150-2175
Country : US
Telephone Number : 812-221-1186
Fax Number : 949-882-0452
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2023
Last Update Date : 03/02/2026

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Directions to “ KIRSTEN BAILEY DERICKS PA-C” Practice Location

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