Healthcare Provider Details

I. General information

NPI: 1932907912
Provider Name (Legal Business Name): DEREK SCHMIDT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S BROWN ST
SPRINGFIELD TN
37172-2920
US

IV. Provider business mailing address

2008 COPPER KETTLE CIR
PLEASANT VIEW TN
37146-7023
US

V. Phone/Fax

Practice location:
  • Phone: 615-384-4504
  • Fax:
Mailing address:
  • Phone: 615-428-5063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number276861
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number276861
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: