MR. BRANDT DERRICKSON (NPI# 1932650736) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932650736 |
| Entity Type | Individual |
| Full Name | MR. BRANDT DERRICKSON |
| Credential | ATC |
| Practice Address |
1155 W Parkview St Ste 2d Bolivar MO 65613-7800 |
| Mailing Address |
1500 N Oakland Ave Bolivar MO 65613-3011 |
| Practice Telephone | 4177772663 |
| Practice Fax Number | 4173262666 |
| Mailing Telephone | 4173266000 |
| Mailing Fax Number | 4173286338 |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2016-10-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
2016004534 | MO | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
1155 W PARKVIEW ST STE 2D |
| City | BOLIVAR |
| State | MO |
| Zip Code | 65613-7800 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366074817 | Retha Marceleen Dawes | Physician Assistant | 1155 W Parkview St Ste 2d, Bolivar, MO 65613-7800 | 2020-02-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891301552 | Casablanca Care Center, LLC | Home Health | 524 S. Albany Avenue, Bolivar, MO 65613 | 2020-09-18 |
| 1669087045 | Revive Medical LLC | Durable Medical Equipment & Medical Supplies | 5000, S Scenic, Bolivar, MO 65613 | 2020-09-11 |
| 1669097119 | Melanie Nicole Beckham | Nurse Practitioner | 1100 South Springfield Ave, Suite B, Bolivar, MO 65613 | 2020-06-10 |
| 1932754744 | Caitlin M Williams | Specialist/Technologist | 1260 S Pike Avenue, Bolivar, MO 65613 | 2019-08-08 |
| 1073022406 | Jacquelyn Rose Kemnic | Dietitian, Registered | Heart Center, 1500 N Oakland Ave, Willard, MO 65613 | 2017-09-28 |
| 1164897161 | Ozarks Resource Group | Clinic/Center | 203 E. Broadway St., Bolivar, MO 65613 | 2015-12-02 |
| 1962895292 | Professional Christian Counseling | Counselor | 4888 S 139th Road, Bolivar, MO 65613 | 2015-03-11 |
| 1073916573 | Scott Leslie Dennis | Physician Assistant | 1500 North Oakland Ave, Citizens Memorial Hospital, Bolivar, MO 65613 | 2014-09-29 |
| 1053712109 | Citizens Memorial Hospital District | Pharmacy | 1301-b North Oakland, Bolivar, MO 65613 | 2014-09-09 |
| 1740680453 | Jamee M Stimpson | Occupational Therapist | 454 S. Main Avenue, Bolivar, MO 65613 | 2014-08-29 |
| Find all providers in zip 65613 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932754744 | Caitlin M Williams | Specialist/Technologist | 1260 S Pike Avenue, Bolivar, MO 65613 | 2019-08-08 |
| 1578555868 | Todd Allen John | Specialist/Technologist | 1600 University Ave, Bolivar, MO 65613-2578 | 2005-08-22 |
| 1255945267 | Kara Mullen | Specialist/Technologist | 1600 University Ave, Bolivar, MO 65613-2578 | 2020-09-07 |
| 1356837694 | Katelynn Stewart | Specialist/Technologist | 1500 N Oakland Ave, Bolivar, MO 65613-3099 | 2018-07-10 |
| 1083135081 | Alex Harrison | Specialist/Technologist | 1600 University Ave, Bolivar, MO 65613-2578 | 2017-06-29 |
| 1619412889 | Kylie Heim | Specialist/Technologist | 1600 University Ave, Bolivar, MO 65613-2578 | 2016-12-27 |
| 1871949529 | Johnnie Jo Hudgings | Specialist/Technologist | 1600 University Ave, Bolivar, MO 65613-2578 | 2016-05-12 |
| 1336593730 | Kristen Davern | Specialist/Technologist | 1600 University Ave, Meyer Wellness Center, Bolivar, MO 65613-2578 | 2016-04-21 |
| 1063872281 | Matthew Dean Loyd | Specialist/Technologist | 1600 University Ave, Bolivar, MO 65613-2578 | 2016-03-01 |
| 1518378108 | Tony Harris | Specialist/Technologist | 1600 University Ave, Meyer Wellness Center, Bolivar, MO 65613-2578 | 2014-05-16 |
| Find all providers in BOLIVAR | ||||
Please comment or provide details below to improve the information on MR. BRANDT 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.