MR. DEREK BRENT KORDENBROCK (NPI# 1245579408) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245579408 |
| Entity Type | Individual |
| Full Name | MR. DEREK BRENT KORDENBROCK |
| Credential | NP |
| Practice Address |
625 Sw Ramsey Ave Ste A Grants Pass OR 97527-5808 |
| Mailing Address |
2620 E Barnett Rd Ste H Medford OR 97504-8383 |
| Practice Telephone | 5415072300 |
| Practice Fax Number | 5415072301 |
| Mailing Telephone | 5417894281 |
| Mailing Fax Number | 5417892558 |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2016-12-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
22446 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
201604376NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LX0106X |
Nurse Practitioner Specialization: Occupational Health |
22446 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LX0106X |
Nurse Practitioner Specialization: Occupational Health |
201604376NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
625 SW RAMSEY AVE STE A |
| City | GRANTS PASS |
| State | OR |
| Zip Code | 97527-5808 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528618600 | Sandra J Campos | Technician | 365 Sleepy Hollow Loop, Grants Pass, OR 97527 | 2019-09-19 |
| 1720501026 | Kelly Bates | Massage Therapist | 501 Cheney Creek Rd, Grants Pass, OR 97527 | 2017-07-19 |
| 1740650134 | Sara Brelsford | Nurse Practitioner | 1075 Sw Grandview Avenue, Suite 200, Grants Pass, OR 97527 | 2015-09-29 |
| 1962816348 | Kimberly Hathaway | Counselor | 320 Ramsey Place, Grants Pass, OR 97527 | 2014-06-13 |
| 1801216999 | Christina Ann Marie Schultz | Massage Therapist | 242 Curtis Drive, Grants Pass, OR 97527 | 2014-04-16 |
| 1013343359 | Shaunte Angelique Duron | Counselor | 711 Sw Ramsey Avenue, Grants Pass, OR 97527 | 2013-09-18 |
| 1063848547 | Megan Faye Armstrong | Behavioral Analyst | 715 Ramsey Aveenue, Grants Pass, OR 97527 | 2013-09-17 |
| 1124454608 | Mark Albert Cook | Behavioral Analyst | 1153 Sw Cal Allen Lane, Grants Pass, OR 97527 | 2013-09-17 |
| 1952741969 | Mitchell K Sheeler | Denturist | 1850 Williams Hwy, Grants Pass, OR 97527 | 2013-07-05 |
| 1790038339 | White City Vamc | Clinic/Center | 1877 Williams Highway, Grants Pass, OR 97527 | 2012-10-19 |
| Find all providers in zip 97527 | ||||
| Taxonomy Code | 363LX0106X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Occupational Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114144193 | James D Barger | Nurse Practitioner | 9290 Se Sunnybrook Blvd, Suite 210, Clackamas, OR 97015-6899 | 2007-04-19 |
| 1649305764 | Helen Josey | Nurse Practitioner | 781 Black Oak Dr, Suite 102, Medford, OR 97504-9502 | 2007-02-21 |
| City | GRANTS PASS |
| Zip Code | 97527 |
Please comment or provide details below to improve the information on MR. DEREK BRENT KORDENBROCK.
| 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.