Kelly Nicole Derwick, RDN, LN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

10167 Issued in FL

Practice address

119 SE 39TH St
Cape Coral, FL 33904

Phone

(239) 910-3871

NPI assigned

Dec 8, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Kelly Nicole Esterline Former name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Florida Kidney Physicians LLCGroup PAC ID 4385925650, 167 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/15644/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Florida Kidney Physicians, LLC

  • Nephrology Physician
  • Temple Terrace, FL
  • NPI 1760831564
  Medicare reassignment Care Compare group NPD
• Florida Kidney Physicians , LLC

  • Nephrology Physician
  • Melbourne, FL
  • NPI 1205506722
  NPD
• Proactive Plates LLC

  • Registered Dietitian
  • Cape Coral, FL
  • NPI 1053286740

  Dietitian, Registered

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777852800000",
    "number": "1033715727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 SE 39TH ST",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339048338",
            "telephone_number": "239-910-3871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 SE 39TH ST",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "33904",
            "telephone_number": "239-910-3871"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2852 Tamiami Trl Ste 1",
            "address_purpose": "LOCATION",
            "city": "Port Charlotte",
            "state": "FL",
            "postal_code": "339525100",
            "country_code": "US",
            "telephone_number": "941-505-8720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERWICK",
        "first_name": "KELLY",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "RDN, LN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-08",
        "last_updated": "2026-05-04",
        "certification_date": "2026-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "10167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA DEPARTMENT OF HEALTH",
            "identifier": "10167",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "ESTERLINE",
            "middle_name": "NICOLE",
            "prefix": "MS.",
            "credential": "RDN, LN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Registered Dietitian in Cape Coral, FL
• Providers in Cape Coral, FL by specialty
• Registered Dietitian in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.