Active NPI
Osayamen Dereng
- Psychiatric/Mental Health Nurse Practitioner
- Antioch, CA
National Provider Identifier
1326591595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 95005210
- Practice address
- 5497 Rathdrum Way
Antioch, CA 94531-8681 - Phone
- (510) 415-1235
- NPI assigned
- Jul 25, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 634659 | CA | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 95005210 | CA | Primary |
Addresses
Primary practice location
5497 Rathdrum Way
Antioch, CA 94531-8681
Mailing address
5497 Rathdrum Way
Antioch, CA 94531-8681
Phone (510) 415-1235
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95005210 | CA | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1469404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558051200000",
"number": "1326591595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5497 RATHDRUM WAY",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945318681",
"telephone_number": "510-415-1235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5497 RATHDRUM WAY",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945318681",
"telephone_number": "510-415-1235"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERENG",
"first_name": "OSAYAMEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-25",
"last_updated": "2019-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "CA",
"license": "634659",
"primary": false
},
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "CA",
"license": "95005210",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Antioch, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.