Tina Faith Derr, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA60426271 Issued in WA

Practice address

1012 South Third Street
Columbia Family Clinic
Dayton, WA 99328

Phone

(509) 382-3200

Fax

(509) 382-2748

NPI assigned

Nov 16, 2005

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1093797961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 SOUTH THIRD STREET",
            "city": "DAYTON",
            "state": "WA",
            "postal_code": "99328",
            "telephone_number": "509-382-2531",
            "fax_number": "509-382-9359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 SOUTH THIRD STREET",
            "address_2": "COLUMBIA FAMILY CLINIC",
            "city": "DAYTON",
            "state": "WA",
            "postal_code": "99328",
            "telephone_number": "509-382-3200",
            "fax_number": "509-382-2748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERR",
        "first_name": "TINA",
        "middle_name": "FAITH",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-16",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2004-0030",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60426271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE",
            "identifier": "PA2004-0030",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "83320253",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Rene Czapka, NP-C
• Paris Davis, MSW
• Shelli Davis
• Dayton Chiropractic Inc
• Dayton School District 2
• Dr. Millgard
• Kenneth Dyball, PAC
• Richard G Edison, PA-C
• Laurence A Eidt, M.D.
• Elk Drug Inc (Elk Drug)

• Physician Assistant in Dayton, WA
• Providers in Dayton, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.