MEDICARE: KAYLEE MARIE DERRA FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1000243-NP	CO

General Provider Information

NPI Number	:	1528744216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEE MARIE DERRA FNP-BC

Provider Business Mailing Address
First Line	:	12731 SCENIC WALK DR
Second Line	:
City	:	PEYTON
State	:	CO
Zip	:	80831-4602
Country	:	US
Telephone Number	:	402-540-1235
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 N CIRCLE DR STE 210
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-8102
Country	:	US
Telephone Number	:	719-228-9440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	08/11/2025

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