Healthcare Provider Details

I. General information

NPI: 1205262011
Provider Name (Legal Business Name): DERINDA DEE UPTON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 VALLEY VIEW LN STE 400
DALLAS TX
75244-5071
US

IV. Provider business mailing address

4055 VALLEY VIEW LN STE 400
DALLAS TX
75244-5071
US

V. Phone/Fax

Practice location:
  • Phone: 865-227-0244
  • Fax:
Mailing address:
  • Phone: 865-227-0244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number17647
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN17647
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: