MS. SUSAN M DERIVAS (NPI# 1851493829) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851493829 |
| Entity Type | Individual |
| Full Name | MS. SUSAN M DERIVAS |
| Credential | NP |
| Practice Address |
1651 E 70th St # 382 Shreveport LA 71105-5115 |
| Mailing Address |
10170 Berrywood Cir Shreveport LA 71106-7692 |
| Practice Telephone | 3185605883 |
| Practice Fax Number | 3187161590 |
| Mailing Telephone | 3185605883 |
| Mailing Fax Number | 3187161590 |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2020-06-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
079944-03962 | LA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1032026 | 05 | |
| TX | APRN LICENSE | 658352 | 01 |
| LA | PRESCRIPTIVE AUTHORITY NO | 210016 | 01 |
| LA | STATE APRN LICENSE | 079944-03962 | 01 |
| Street Address |
1651 E 70TH ST # 382 |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71105-5115 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043601685 | Psychiatric Nurse Practitioner Services, LLC | Nurse Practitioner | 1651 E 70th St # 382, Shreveport, LA 71105-5115 | 2015-02-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699245928 | Misty Johnetta Ross | Counselor | 2942 Knight St., Bldg. 4 Suite 426, Shreveport, LA 71105 | 2018-11-29 |
| 1205301868 | Tatjhana Maury | Case Manager/Care Coordinator | 3325 Youree Drive, Shreveport, LA 71105 | 2018-10-10 |
| 1245710920 | Jefferey Douglas Adair Md | Non-Pharmacy Dispensing Site | 8860 Fern Ave., Suite 120, Shreveport, LA 71105 | 2018-08-21 |
| 1679059539 | Michael E Woolbert Dds LLC | Dentist | 7600 Fern Avenue, Building 1100, Shreveport, LA 71105 | 2018-07-13 |
| 1881195675 | Adiba Bibi | Pharmacist | 3555 Greenwood Road, Walgreens, Shreveport, LA 71105 | 2018-02-27 |
| 1740796655 | Allison Borel | Counselor | 2020 E 70th St Ste 201, Shreveport, LA 71105 | 2017-12-15 |
| 1073028148 | Valerie Wooten Barcelona | Physical Therapist | 130 Kayla Street, Shreveport, LA 71105 | 2017-12-11 |
| 1710497615 | Jimmy Carroll | Counselor | 2960 Knight St, Suite 110, Shreveport, LA 71105 | 2017-10-05 |
| 1932618444 | David Louis Bennett | Counselor | 3007 Knight St., Suite 200, Shreveport, LA 71105 | 2017-09-27 |
| 1619496452 | Shaqwana Hodge | Counselor | 2920 Knight St. Suite 110, Shreveport, LA 71105 | 2017-09-13 |
| Find all providers in zip 71105 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942660287 | Larry David Allen Jr. | Nurse Practitioner | 4416 Orchid St, Shreveport, LA 71105-3130 | 2016-02-29 |
| 1912389503 | Lisa Jones Baker | Nurse Practitioner | 1002 Highland Ave Fl 2, Shreveport, LA 71101-4143 | 2015-06-19 |
| 1407264989 | Jaschandria Bailey | Nurse Practitioner | Brentwood Hospital, 1006 Highland Avenue, Shreveport, LA 71101-4202 | 2014-07-28 |
| 1518574441 | Jadebrey Vyshette Kennon | Nurse Practitioner | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-09-24 |
| 1740801752 | Mitsi Tonette Long | Nurse Practitioner | 3341 Youree Dr Ste 205, Shreveport, LA 71105-2149 | 2020-04-30 |
| 1104471382 | Juanita Carolyn Roberts | Nurse Practitioner | 1006 Highland Ave, Shreveport, LA 71101-4103 | 2019-08-05 |
| 1841792249 | James G Jones IIi | Nurse Practitioner | 1002 Highland Ave, Shreveport, LA 71101-4143 | 2018-03-02 |
| 1225539984 | Marnitta Demming | Nurse Practitioner | 7591 Fern Ave Ste 1705, Shreveport, LA 71105-5749 | 2018-02-27 |
| 1912417262 | Janey Gaston | Nurse Practitioner | 8731 Park Plaza Dr, Shreveport, LA 71105-5682 | 2017-10-01 |
| 1043601685 | Psychiatric Nurse Practitioner Services, LLC | Nurse Practitioner | 1651 E 70th St # 382, Shreveport, LA 71105-5115 | 2015-02-17 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71105 |
Please comment or provide details below to improve the information on MS. SUSAN M DERIVAS.
| 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.