Alyssa Kayle Derrick, L.M.P.

Primary specialty

SpecialistTaxonomy code 174400000X

License

MA60253192 Issued in WA

Practice address

4803 84TH St SW
Mukilteo, WA 98275-3023

Phone

(425) 290-6024

NPI assigned

Jan 2, 2012

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Serene Lake Massage Therapy

  • Specialist
  • Lynnwood, WA
  • NPI 1114053790
  NPD (past)

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

{
    "created_epoch": "1325462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325462400000",
    "number": "1306116736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5521 186TH PL SW",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980374325",
            "telephone_number": "425-776-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4803 84TH ST SW",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "982753023",
            "telephone_number": "425-290-6024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERRICK",
        "first_name": "ALYSSA",
        "middle_name": "KAYLE",
        "name_prefix": "Miss",
        "credential": "L.M.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-02",
        "last_updated": "2012-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "MA60253192",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L.M.P.",
            "identifier": "MA60253192",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jillianna Davis
• Rachel Sabandal Day, N.D.
• Jacqueline De Leon-Estes, DMD
• Eileen Delacruz, MD
• Jared Dell, LPN
• Deshael Mental Health Services PLLC
• Megan Rey Devlin
• Katherine Dodge, MSN
• Monica Donoghue Shallow
• Katherine Doughty, MS, MPH, RD, IBCLC

• Specialist in Mukilteo, WA
• Providers in Mukilteo, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2012; 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.