Individual provider Active NPI

Emily Nicole Derenberger

  • Early Intervention Provider Agency
  • Parkersburg, WV
National Provider Identifier
1174331979
Registry record updated Dec 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
License
252Y00000X Issued in WV
Practice address
1917 Dudley Ave
Parkersburg, WV 26101-2674
Phone
(304) 580-1242
NPI assigned
Dec 26, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X 252Y00000X WV Primary

Addresses

Primary practice location

1917 Dudley Ave
Parkersburg, WV 26101-2674

Mailing address

1917 Dudley Ave
Parkersburg, WV 26101-2674
Phone (304) 580-1242

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
252Y00000XWVMDEarly Intervention Provider Agency

NPI Registry JSON

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

{
    "created_epoch": "1735171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735171200000",
    "number": "1174331979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1917 DUDLEY AVE",
            "city": "PARKERSBURG",
            "state": "WV",
            "postal_code": "261012674",
            "telephone_number": "304-580-1242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1917 DUDLEY AVE",
            "city": "PARKERSBURG",
            "state": "WV",
            "postal_code": "261012674",
            "telephone_number": "304-580-1242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERENBERGER",
        "first_name": "EMILY",
        "middle_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-26",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "WV",
            "license": "252Y00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Parkersburg, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2024; 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.