Active NPI
Derek L Nissley, ATC
- Athletic Trainer
- Mount Joy, PA
National Provider Identifier
1235216300
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- RT002083A
- Practice address
- 1025 Koser Rd
Mount Joy, PA 17552 - Phone
- (717) 314-9537
- NPI assigned
- Nov 1, 2006
- Last updated
- Nov 30, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | RT002083A | PA | Primary |
Addresses
Primary practice location
1025 Koser Rd
Mount Joy, PA 17552
Mailing address
1025 Koser Rd
Mount Joy, PA 17552-9288
Phone (717) 314-9537
Other practice location 1
915 Anderson Ferry Rd
Mount Joy, PA 17552-9747
Phone (717) 653-1871
Other practice location 2
915 Anderson Ferry Rd
Mount Joy, PA 17552-9747
Phone (717) 653-1871
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
| License | State | Type | Specialty |
|---|---|---|---|
| RT002083A | PA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543536000000",
"number": "1235216300",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1025 KOSER RD",
"city": "MOUNT JOY",
"state": "PA",
"postal_code": "175529288",
"telephone_number": "717-314-9537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1025 KOSER RD",
"city": "MOUNT JOY",
"state": "PA",
"postal_code": "17552",
"telephone_number": "717-314-9537"
}
],
"practiceLocations": [
{
"address_1": "915 Anderson Ferry Rd",
"address_purpose": "LOCATION",
"city": "Mount Joy",
"state": "PA",
"postal_code": "175529747",
"country_code": "US",
"telephone_number": "717-653-1871",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "915 Anderson Ferry Rd",
"address_purpose": "LOCATION",
"city": "Mount Joy",
"state": "PA",
"postal_code": "175529747",
"country_code": "US",
"telephone_number": "717-653-1871",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NISSLEY",
"first_name": "DEREK",
"middle_name": "L",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2018-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "PA",
"license": "RT002083A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Joy, PA
- Mount Joy Foot & Ankle Associates, PC
- Taylor Muir, HEALTH COACH
- Scott Lee Munson, RBT
- Lauren Murphy
- New Life Counseling Services, LLC
- Vicky Lynn Noll, CMT
- Ngozi Blessing Nzeribe, LBS
- Pennsylvania CVS Pharmacy, L.L.C. (CVS Pharmacy #02494)
- Lance Jacob Pietropola, D.D.S.
- Pinnacle Health Regional Physicians (Family Health Center of Mount Joy)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.