DERRICK PELTON (NPI# 1609208354) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609208354 |
| Entity Type | Individual |
| Full Name | DERRICK PELTON |
| Credential | APN |
| Practice Address |
2360 Mendocino Ave Ste A4 Santa Rosa CA 95403-3154 |
| Mailing Address |
325 Distel Cir Los Altos CA 94022-1408 |
| Practice Telephone | 8009725547 |
| Mailing Telephone | 8009725547 |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2020-06-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
95012148 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2360 MENDOCINO AVE STE A4 |
| City | SANTA ROSA |
| State | CA |
| Zip Code | 95403-3154 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942740972 | Jenelle Gonzalez | Nurse Practitioner | 2360 Mendocino Ave Ste A4, Santa Rosa, CA 95403-3154 | 2017-02-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912549841 | Abundance Acupuncture Healing Clinic | Acupuncturist | 3410 Mendocino Avenue, Santa Rosa, CA 95403 | 2019-10-11 |
| 1982161337 | Crystal J Ward | Registered Nurse | 2350 Mendocino Ave, Ste A4, Santa Rosa, CA 95403 | 2019-02-21 |
| 1033674379 | George Edward Griese | Respiratory Therapist, Registered | 501 Bicentennial Way, Santa Rosa, CA 95403 | 2019-01-31 |
| 1508320672 | East-west Natural Medicine Inc. | Acupuncturist | 2200 Range Ave #207, Santa Rosa, CA 95403 | 2019-01-23 |
| 1316410640 | Lionel C Cooper | Counselor | 315 Mark West Springs Road, Santa Rosa, CA 95403 | 2019-01-09 |
| 1326519182 | Jkb Solutions Inc. | In Home Supportive Care | 3554 Round Barn Boulevard, Suite 311, Santa Rosa, CA 95403 | 2018-12-05 |
| 1487121265 | Catholic Charities of The Diocese of Santa Rosa | Clinic/Center | 987 Airway Ct, Santa Rosa, CA 95403 | 2018-10-30 |
| 1447746524 | Lisa Jean Quang | Optometrist | 3925 Old Redwood, Medical Office Building 4, Suite 141, Santa Rosa, CA 95403 | 2018-07-02 |
| 1598253353 | Jennifer Renee Lummus | Community Health Worker | 3614 Condo Court, Santa Rosa, CA 95403 | 2018-04-27 |
| 1871042366 | Sadie Thuet | Marriage & Family Therapist | 3434 A Mendocino Ave, Santa Rosa, CA 95403 | 2016-09-26 |
| Find all providers in zip 95403 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780160234 | Susan English Knowles | Nurse Practitioner | 3383 Airway Dr, Santa Rosa, CA 95403-2005 | 2018-07-18 |
| 1912498726 | Lydia Ann Smith | Nurse Practitioner | 2375 Range Ave Unit 1, Santa Rosa, CA 95403-9419 | 2018-05-29 |
| 1659870186 | Shannon Cross Todd | Nurse Practitioner | 4729a Hoen Ave, Santa Rosa, CA 95405-7862 | 2018-02-11 |
| 1093222408 | Mary Esther Andich | Nurse Practitioner | 2800 Cleveland Ave Ste A, Santa Rosa, CA 95403-2784 | 2018-01-08 |
| 1316473697 | Renee Novakovich | Nurse Practitioner | 704 Adobe Dr, Santa Rosa, CA 95404-2706 | 2017-05-05 |
| 1780139634 | Robin Shank Sanderson | Nurse Practitioner | 751 Lombardi, Santa Rosa, CA 95407 | 2016-08-22 |
| 1437549235 | Jennifer Takagi | Nurse Practitioner | 1803 Aspen Leaf Ln, Santa Rosa, CA 95401-4295 | 2015-01-31 |
| 1164828828 | Danielle J Daye | Nurse Practitioner | 50 Montgomery Dr, Santa Rosa, CA 95404-6615 | 2014-11-07 |
| 1225313869 | Kristine Monson Brown | Nurse Practitioner | 1501 Mendocino Ave, Santa Rosa, CA 95401-4332 | 2011-10-14 |
| 1689975153 | Lydia Dominguez | Nurse Practitioner | Highway 107 & La Feria Ave., Santa Rosa, TX 78593 | 2010-11-15 |
| Find all providers in SANTA ROSA | ||||
| City | SANTA ROSA |
| Zip Code | 95403 |
Please comment or provide details below to improve the information on DERRICK PELTON.
| 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.