MRS. MARY ANNE DERRICO (NPI# 1245581974) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245581974 |
| Entity Type | Individual |
| Full Name | MRS. MARY ANNE DERRICO |
| Credential | APRN-CNP |
| Practice Address |
13631 Ne Townley Rd Elgin OK 73538-3705 |
| Practice Telephone | 5805120746 |
| Practice Fax Number | 5802500506 |
| Mailing Telephone | 5805120746 |
| Mailing Fax Number | 5802500506 |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2013-03-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
49043 | OK | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | OKLAHOMA STATE BUREAU OF NARCOTICS AND DANGEROUS DRUG CONTROL RE | 45113 | 01 |
| Street Address |
13631 NE TOWNLEY RD |
| City | ELGIN |
| State | OK |
| Zip Code | 73538-3705 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770196966 | Kellen J Allen | Physical Therapist | 922 North A St, Elgin, OK 73538 | 2020-08-26 |
| 1184183873 | Daystar Counseling & Consulting Services, LLC | Community/Behavioral Health | 7846 Us-277, Suite 3, Elgin, OK 73538 | 2019-03-13 |
| 1821444126 | Elizabeth Foster | Case Manager/Care Coordinator | 1103 4th Pl, Elgin, OK 73538 | 2016-05-05 |
| 1992044044 | Christie Arnold Leal | Family Medicine | 7939 Us Hwy 277, Elgin, OK 73538 | 2013-02-10 |
| 1184991820 | Tanja N Weddington | Counselor | 219 Ne Sunset Dr, Elgin, OK 73538 | 2011-11-23 |
| 1124271887 | Elgin Physical Therapy, Pllc | Physical Therapist | 7602 Us Highway 277, Elgin, OK 73538 | 2008-10-28 |
| 1811182132 | Victory Medical Equipment LLC | Durable Medical Equipment & Medical Supplies | 8209 Hwy 277 Ste C, Victory Medical Equipment LLC, Elgin, OK 73538 | 2007-09-10 |
| 1255478723 | Victory Medical Equipment | Durable Medical Equipment & Medical Supplies | 104 Thoma Drive, Suite 3, Elgin, OK 73538 | 2007-01-31 |
| 1760566293 | Lewis J Litwack | Family Medicine | 7936 Us Hwy 277, Elgin, OK 73538 | 2006-10-24 |
| 1932299401 | Elgin Public Schools | Local Education Agency (LEA) | 721 J St., Elgin, OK 73538 | 2006-10-13 |
| Find all providers in zip 73538 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801496328 | Kellie Soria | Nurse Practitioner | 8600 Showers Dr, Elgin, TX 78621-5278 | 2020-10-26 |
| 1669079901 | Kelley Brown Davis | Nurse Practitioner | 2689 Us-1, Elgin, SC 29045 | 2020-10-08 |
| 1083266878 | Jean K Kombwa | Nurse Practitioner | 66 Grove Ct, Elgin, IL 60120-5588 | 2019-07-11 |
| 1407416324 | Gloria Benoit Williams | Nurse Practitioner | 889 Royal Oak Way, Elgin, SC 29045-8012 | 2019-06-13 |
| 1538681671 | Josephina Pilolli | Nurse Practitioner | 2490 Bushwood Dr, Unit F, Elgin, IL 60124 | 2017-07-11 |
| 1598204638 | Kimberly Horton | Nurse Practitioner | 153 Dawson Dr, Elgin, IL 60120-6409 | 2017-02-22 |
| 1073961314 | Annie Kluch | Nurse Practitioner | 801 Villa St, Elgin, IL 60120-8001 | 2016-05-26 |
| 1639543937 | Grace Marie Roxas | Nurse Practitioner | 2025 Salem Road, Elgin, IL 60123-9006 | 2015-11-24 |
| 1942674585 | Monica Rose Herdrich | Nurse Practitioner | 1665 Larkin Ave, Elgin, IL 60123-5977 | 2015-11-19 |
| 1073995916 | Betty Lois Pratt | Nurse Practitioner | 373 Summit St Ste 102, Elgin, IL 60120-3748 | 2015-06-28 |
| Find all providers in ELGIN | ||||
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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.