DR. JODA P. DERRICKSON (NPI# 1710347034) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710347034 |
| Entity Type | Individual |
| Full Name | DR. JODA P. DERRICKSON |
| Credential | PH.D, RD, ACSM EP-C |
| Practice Address |
580 Kawailoa Rd Kailua HI 96734-3145 |
| Practice Telephone | 8082204165 |
| Mailing Telephone | 8082204165 |
| Enumeration Date | 2016-02-29 |
| Last Update Date | 2018-04-18 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133VN1006X |
Dietitian, Registered Specialization: Nutrition, Metabolic |
Dietary & Nutritional Service Providers |
| Street Address |
580 KAWAILOA RD |
| City | KAILUA |
| State | HI |
| Zip Code | 96734-3145 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497387526 | Allie Trambow Ledbetter | Behavior Technician | 580 Kawailoa Rd, Kailua, HI 96734-3145 | 2020-02-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144828773 | About Face Kailua, LLC | General Practice | 970 N. Kalahea Ave, Suite A-11, Kailua, HI 96734 | 2020-10-15 |
| 1134726979 | Sara Eller | Radiology | Building 6905 Mcbh, Pearl Harbor, HI 96734 | 2020-10-05 |
| 1205441888 | William Andrew Fitzpatrick | Military Health Care Provider | Bldg 6905, Mcbh, HI 96734 | 2020-09-10 |
| 1215549670 | Joseph Frabotta | Military Health Care Provider | 6894r Mokapu Rd, Kailua, HI 96734 | 2020-08-18 |
| 1437776366 | Amanda Lindsay Krasniewski | Behavior Technician | 203 Kapaa Quarry Place, Suite #5002, Kailua, HI 96734 | 2020-06-26 |
| 1760007108 | Yoli Gabrielle Teran | Behavior Technician | 203 Kapaa Quarry Pi #5002, Kailua, HI 96734 | 2020-06-11 |
| 1902427206 | Amberlie Remily | Behavior Technician | 203 Kapaa Quarry Pl. #5002, Kailua, HI 96734 | 2020-04-28 |
| 1417586264 | Jennifer Eng | Marriage & Family Therapist | 6842 Harris Ave, Kailua, HI 96734 | 2020-04-03 |
| 1023644523 | Roxan Mae Sardido Okamoto | Specialist | 1178 Lunahana Place, Kailua, HI 96734 | 2020-03-16 |
| 1811520240 | Sherly Macion | Registered Nurse | 720 A1 Kihapai Place, Kailua, HI 96734 | 2020-02-13 |
| Find all providers in zip 96734 | ||||
| Taxonomy Code | 133VN1006X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| Specialization | Nutrition, Metabolic |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063727436 | Deanna N Nakamura | Dietitian, Registered | 41-1347 Kalanianaole Hwy, Waimanalo, HI 96795-1247 | 2010-08-10 |
| 1245253665 | Doris Yamanoha | Dietitian, Registered | 868 Ululani St, Hilo, HI 96720-3913 | 2006-07-26 |
Please comment or provide details below to improve the information on DR. JODA P. DERRICKSON.
| 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.