Kenneth L Derrington, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

R9A11 Issued in MO

Practice address

156 Missouri Blvd Ste B
Gravois Mills, MO 65037-5394

Phone

(573) 374-5263

Fax

(573) 374-4933

NPI assigned

Jun 17, 2005

Sex

Male

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Stone Castle Family Practice LLC

  • Primary Care Clinic/Center
  • Camdenton, MO
  • NPI 1972783058

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521417600000",
    "number": "1124023940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1519",
            "city": "LAURIE",
            "state": "MO",
            "postal_code": "650381519",
            "telephone_number": "573-374-5800",
            "fax_number": "573-374-5697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 MISSOURI BLVD STE B",
            "city": "GRAVOIS MILLS",
            "state": "MO",
            "postal_code": "650375394",
            "telephone_number": "573-374-5263",
            "fax_number": "573-374-4933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERRINGTON",
        "first_name": "KENNETH",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-17",
        "last_updated": "2018-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R9A11",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201366010",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MO LICENSE",
            "identifier": "R9A11",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Barrett, LAC
• Brandon C.W. Brown, MD
• Daniel James Cerra, PHARMD
• Kimberly Collins, ANP
• Dental Professionals of Missouri, Richard Straus, D.M.D., P.C.
• Penny A Dunning- Newell, APRN FNP BC
• Mark A Handley, DDS
• Jamaica Cottage II , Inc
• Jamaica Cottage Isl II
• McKenna Pierce, MSN, APRN, FNP-C

• Family Medicine Physician in Gravois Mills, MO
• Providers in Gravois Mills, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2018; 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.