Derganc, Kelly Marie

Derganc, Kelly Marie is an individual health care provider with primary practice located at 100 Mercy Way , Joplin MO 64804-4524. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as her primary health care specialty. Derganc, Kelly Marie can be contacted via phone (417) 556-2727.

Contact Information

Primary practice address
100 Mercy Way Joplin MO 64804-4524
Phone: (417) 556-2727
Fax: (785) 357-6589
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 141458 Kansas
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 2012035666 Missouri

Profile Details

NPI number 1881900058
LBN Legal business name Derganc, Kelly Marie
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 26th, 2010
Last updated Jun 14th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881900058 NPPES
Kansas Other 068002116 MEDICARE PTAN
Kansas MEDICAID 200674390B MEDICARE PTAN

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