DEREK BAKARI MCKIBBEN (NPI# 1205485711) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205485711 |
| Entity Type | Individual |
| Full Name | DEREK BAKARI MCKIBBEN |
| Practice Address |
92 W Lowder St Macclenny FL 32063-2676 |
| Mailing Address |
4300 Sw 13th St Gainesville FL 32608-4006 |
| Practice Telephone | 3523745615 |
| Mailing Telephone | 3523745600 |
| Mailing Fax Number | 3522242741 |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2019-09-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| Street Address |
92 W LOWDER ST |
| City | MACCLENNY |
| State | FL |
| Zip Code | 32063-2676 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174673750 | Linda Ann Parrish | Marriage & Family Therapist | 92 W Lowder St, Macclenny, FL 32063-2676 | 2007-01-12 |
| 1104466812 | Amanda Jean Bondie | Case Manager/Care Coordinator | 92 W Lowder St, Macclenny, FL 32063-2676 | 2020-01-10 |
| 1730722059 | Joshua Klein Allen | Counselor | 92 W Lowder St, Macclenny, FL 32063-2676 | 2019-10-18 |
| 1013570514 | Cristin Ellis | Case Manager/Care Coordinator | 92 W Lowder St, Macclenny, FL 32063-2676 | 2019-04-19 |
| 1023588183 | Carolyn Mccrary | Nurse's Aide | 92 W Lowder St, Macclenny, FL 32063-2676 | 2018-12-03 |
| 1578033627 | Dinna Andrews | Counselor | 92 W Lowder St, Macclenny, FL 32063-2676 | 2018-12-03 |
| 1023594868 | Mary Elizabeth Paul | Counselor | 92 W Lowder St, Macclenny, FL 32063-2676 | 2018-07-16 |
| 1487130225 | Michael Johnson | Case Manager/Care Coordinator | 92 W Lowder St, Macclenny, FL 32063-2676 | 2018-07-16 |
| 1760976476 | Wendy Mcdougald | Case Manager/Care Coordinator | 92 W Lowder St, Macclenny, FL 32063-2676 | 2018-06-16 |
| 1588161582 | Vonceil Parnell Levine | Social Worker | 92 W Lowder St, Macclenny, FL 32063-2676 | 2018-04-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578164976 | Justin Gary Dugger | Pharmacist | 9218 Sr-228 E, Macclenny, FL 32063 | 2020-11-03 |
| 1285175091 | Katie Rourke | Massage Therapist | 6068 -1 Larimer Rd, Macclenny, FL 32063 | 2017-03-13 |
| 1174734073 | Jane Ellen Echterling | Psychologist | Northeast Florida State Hospital, 7487 S. State Road 121, Macclenny, FL 32063 | 2007-05-24 |
| 1992879886 | Baker County Schools | Local Education Agency (LEA) | 290 Jonathan St E, Macclenny, FL 32063 | 2006-11-20 |
| 1306918271 | Baker County School Board | Local Education Agency (LEA) | 290 Jonathan Street East, Macclenny, FL 32063 | 2006-11-15 |
| 1780760967 | Patricia Ann Sova | Pharmacist | 1436 Sw 6th St, Winn Dixie #0144, Macclenny, FL 32063 | 2006-10-31 |
| 1447347992 | Annie Clara Widemond | Pharmacy Technician | 1436 State Road 121 South, Macclenny, FL 32063 | 2006-10-06 |
| 1003900713 | Luna S. Iskander | Psychiatry & Neurology | 7487 South State Road 121, Macclenny, FL 32063 | 2006-10-03 |
| 1558456103 | Cam Hoang | Family Medicine | 7487 South State Road 171, Macclenny, FL 32063 | 2006-10-03 |
| 1245323492 | Raynors Pharmacy Inc | Durable Medical Equipment & Medical Supplies | 698 F W Macclenny Ave, Ste F, Macclenny, FL 32063 | 2006-10-02 |
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| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104466812 | Amanda Jean Bondie | Case Manager/Care Coordinator | 92 W Lowder St, Macclenny, FL 32063-2676 | 2020-01-10 |
| 1013570514 | Cristin Ellis | Case Manager/Care Coordinator | 92 W Lowder St, Macclenny, FL 32063-2676 | 2019-04-19 |
| 1487130225 | Michael Johnson | Case Manager/Care Coordinator | 92 W Lowder St, Macclenny, FL 32063-2676 | 2018-07-16 |
| 1760976476 | Wendy Mcdougald | Case Manager/Care Coordinator | 92 W Lowder St, Macclenny, FL 32063-2676 | 2018-06-16 |
| 1609393081 | Cheryl Dyer | Case Manager/Care Coordinator | 56 N 2nd St, Macclenny, FL 32063-2206 | 2017-08-25 |
| 1508381641 | Tina Ashley | Case Manager/Care Coordinator | 56 N 2nd St, Macclenny, FL 32063-2206 | 2017-08-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164023925 | Eddy David | Case Manager/Care Coordinator | 1118 Grayson Dr, Orlando, FL 32825-6724 | 2020-11-06 |
| 1316547615 | Kyomi Santana | Case Manager/Care Coordinator | 8100 Oak Ln Ste 4048100, Miami Lakes, FL 33016-5820 | 2020-10-27 |
| 1538768072 | Emma Eloisa Cruz | Case Manager/Care Coordinator | 1105 Cobblestone Cir Apt B, Kissimmee, FL 34744-5563 | 2020-10-24 |
| 1891394409 | Ariadna Cannet | Case Manager/Care Coordinator | 27583 Sw 143rd Ct, Homestead, FL 33032-8871 | 2020-10-23 |
| 1952900839 | Yipsia Mayrelis Cordovi Cancio | Case Manager/Care Coordinator | 3837 Sw 79th Ave Apt A, Miami, FL 33155-6755 | 2020-10-21 |
| 1326646985 | Lewis Connects | Case Manager/Care Coordinator | 885 Hickory Ave, Orange City, FL 32763-6864 | 2020-10-15 |
| 1821696071 | Dianelis Ramirez | Case Manager/Care Coordinator | 6245 Dell St, Orlando, FL 32809-4311 | 2020-10-10 |
| 1548867831 | Jessica Bickman | Case Manager/Care Coordinator | 1026 Replica Ave, Sebring, FL 33872-2720 | 2020-10-08 |
| 1447857123 | Omayra Rolon-rivera | Case Manager/Care Coordinator | 1371 Tuscana Ln Apt 6102, Davenport, FL 33896-5302 | 2020-10-05 |
| 1679180392 | Astrid C Montesinos Franco | Case Manager/Care Coordinator | 7656 Nw 5th St Apt 4f, Plantation, FL 33324-1940 | 2020-09-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.