Healthcare Provider Details

I. General information

NPI: 1851029250
Provider Name (Legal Business Name): IRINA DERKACH RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 01/04/2025
Certification Date: 01/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2517 TINMOUTH VALE
LEXINGTON KY
40509-4389
US

IV. Provider business mailing address

2517 TINMOUTH VALE
LEXINGTON KY
40509-4389
US

V. Phone/Fax

Practice location:
  • Phone: 859-913-1082
  • Fax:
Mailing address:
  • Phone: 859-913-1082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: