MR. DEREK R WYNN (NPI# 1043689441) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043689441 |
| Entity Type | Individual |
| Full Name | MR. DEREK R WYNN |
| Credential | PA |
| Practice Address |
607 W Main Street Grangeville ID 83530 |
| Mailing Address |
607 W Main St Grangeville ID 83530-1345 |
| Practice Telephone | 2089831700 |
| Practice Fax Number | 2089834665 |
| Mailing Telephone | 2089831700 |
| Mailing Fax Number | 2089834665 |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2015-09-16 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA-1276 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
607 W MAIN STREET |
| City | GRANGEVILLE |
| State | ID |
| Zip Code | 83530 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386197424 | Tolo Tranportation LLC | Non-emergency Medical Transport (VAN) | 78 Poor Farm Rd, Grangeville, ID 83530 | 2016-07-25 |
| 1528468139 | Joanne M Belch | Counselor | 83 Highway 95 North, Camas Professional Counseling, Grangeville, ID 83530 | 2014-09-02 |
| 1679875462 | Oi Min Anthony Chai | Physical Therapist | 183 Farrens Creek Lane, Grangeville, ID 83530 | 2010-11-30 |
| 1346569647 | Valleyview Recovery | Case Management | 109 S. Mill St., Grangeville, ID 83530 | 2010-05-26 |
| 1760503676 | Clearwater Counseling | Counselor | 318 E. Main, Grangeville, ID 83530 | 2007-04-02 |
| 1659452019 | Bradley J Schaff | Dentist | 615 W North St, Grangeville, ID 83530 | 2006-10-18 |
| 1518051366 | Wayne L Hollopeter | Family Medicine | 721 W. North Street, Grangeville, ID 83530 | 2006-10-03 |
| 1417252719 | Syringa General Hospital District Cif | General Acute Care Hospital | 607 West Main Street, Grangeville, ID 83530 | 2011-01-18 |
| 1669553020 | Allen Raymond Chenoweth | Dentist | 615 W North St, Grangeville, ID 83530 | 2006-10-18 |
| 1417066184 | Kellie June Bruner | Pharmacist | 415 W Main St, Grangeville, ID 83530 | 2006-08-29 |
| Find all providers in zip 83530 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255539441 | Nathan T Winder | Physician Assistant | 607 W Main St, Grangeville, ID 83530-1345 | 2007-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689217911 | David Jeffrey Hanson | Physician Assistant | 740 Mckinley Ave Ste 100, Kellogg, ID 83837-2693 | 2019-10-18 |
| 1871060681 | Travis Henman | Physician Assistant | 1404 Pomerelle Ave Ste 150, Burley, ID 83318-2012 | 2018-10-30 |
| 1952889685 | Cody Mattingly | Physician Assistant | 14601 S Pleasant Valley Rd, Kuna, ID 83634-2728 | 2018-08-03 |
| 1992174072 | Alexa Rhea | Physician Assistant | 2841 Juniper Dr Ste 2, Lewiston, ID 83501-4719 | 2015-09-18 |
| 1407223274 | Michael Kenneth Wucinich | Physician Assistant | 775 Pole Line Rd W Ste 302, Twin Falls, ID 83301-5823 | 2015-08-28 |
| 1811364177 | Ashley Laren Popadics | Physician Assistant | 1510 12th Ave Rd Ste 200, Nampa, ID 83686-6008 | 2015-08-21 |
| 1073915963 | Jessica Bishop | Physician Assistant | 1499 W Hays St, Boise, ID 83702-5029 | 2014-09-23 |
| 1447652813 | Jessea Camille Whitlow | Physician Assistant | 2392 Addison Ave E, Twin Falls, ID 83301-6745 | 2014-09-17 |
| 1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
| 1609204890 | Rachel Sawyer | Physician Assistant | 7405 Wild Horse Way, Nampa, ID 83686-5496 | 2013-10-24 |
| Find all providers with the same taxonomy | ||||
| City | GRANGEVILLE |
| Zip Code | 83530 |
Please comment or provide details below to improve the information on MR. DEREK R WYNN.
| 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.