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General NPI Number Information
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NPI Number | 1184565772
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Entity Type | Individual
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Provider Name | SARA LYNN DERRICK PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/06/2026
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Last Update Date | 04/06/2026
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Provider Practice Location Address
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Address Line | 218 S DENTON RD
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City | NEW ALBANY
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State | MS
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Zip | 38652-2810
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Country | US
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Telephone | 662-598-8141
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Fax |
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Provider Business Mailing Address
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Address Line | 1012 COUNTY ROAD 382
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City | NEW ALBANY
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State | MS
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Zip | 38652-0017
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Country | US
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Telephone | 662-416-9246
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 908326
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License Number State | MS
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