Healthcare Provider Details

I. General information

NPI: 1184565772
Provider Name (Legal Business Name): SARA LYNN DERRICK PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 S DENTON RD
NEW ALBANY MS
38652-2810
US

IV. Provider business mailing address

1012 COUNTY ROAD 382
NEW ALBANY MS
38652-0017
US

V. Phone/Fax

Practice location:
  • Phone: 662-598-8141
  • Fax:
Mailing address:
  • Phone: 662-416-9246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number908326
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: