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General NPI Number Information
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NPI Number | 1538010236
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Entity Type | Organization
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Legal Business Name | MOMENTUM BEHAVIORAL HEALTH GROUP LLC
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Dates
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Enumeration Date | 02/07/2026
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 3211 GRANT LINE RD STE 15
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City | NEW ALBANY
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State | IN
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Zip | 47150-2175
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Country | US
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Telephone | 812-221-1186
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Fax | 949-882-0452
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Provider Business Mailing Address
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Address Line | 4510 CHARLESTOWN RD PMB #110
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City | NEW ALBANY
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State | IN
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Zip | 47150-8513
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Country | US
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Telephone | 812-221-1186
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Fax | 949-882-0452
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Authorized Official
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Title or Position | PROVIDER
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Name | KIRSTEN BAILEY DERICKS
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Credential | PA-C
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Telephone | 812-221-1186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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