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General NPI Number Information
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NPI Number | 1689082174
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Entity Type | Individual
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Provider Name | KATHY DERRICK FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 01/20/2026
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Provider Practice Location Address
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Address Line | 1760 E PECOS RD STE 102
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City | GILBERT
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State | AZ
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Zip | 85295-3201
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Country | US
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Telephone | 480-690-8412
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Fax |
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Provider Business Mailing Address
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Address Line | 4366 S AVENIDA DE ANGELES
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City | GOLD CANYON
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State | AZ
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Zip | 85118-2976
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Country | US
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Telephone | 217-521-8703
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209011668
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License Number State | IL
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