Derin Colvin
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Beaverton, OR
NPI 1346989944 · NPPES record last updated Oct 18, 2024
Key facts
- NPI
- 1346989944
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 10020433 (OR)
- Practice address
- 1975 NW 167TH PL Ste 100-11
Beaverton, OR 97006-4908 - Phone
- (971) 571-5012
- Fax
- (971) 233-6448
- NPI assigned
- Jun 1, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 231751 | AZ | MD | Psychiatric/Mental Health Nurse Practitioner |
| 10020433 | OR | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jagger & Crew International LLC | Psychiatric/Mental Health | Current |
Accepting new patients |
| Serenity TMS Centers LLC | Current |
Accepting new patients |
Locations
1501 N Gilbert Rd
Ste 206
Gilbert, AZ 85234
Phone (480) 626-2024
1166 E Warner Rd
Ste 101
Gilbert, AZ 85296
Phone (480) 570-0497
20950 N Tatum Blvd
Ste 380
Phoenix, AZ 85050
Phone (480) 389-1061
4545 E Chandler Blvd
Ste 308
Phoenix, AZ 85048
Phone (480) 626-2024
2355 E Camelback Rd
Ste 625
Phoenix, AZ 85016
Phone (480) 535-0363
1860 N 95th Ln
Fl 3
Phoenix, AZ 85037
1975 NW 167th Pl
Ste 10011
Beaverton, OR 97006
Phone (971) 238-8092
3300 N Triumph Blvd
Ste 500
Lehi, UT 84043
Phone (801) 821-2333
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 231751 | AZ | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 10020433 | OR | Yes |
Addresses
Primary practice location
1975 NW 167TH PL Ste 100-11
Beaverton, OR 97006-4908
Mailing address
9400 SW Beaverton Hillsdale Hwy Ste 250
Beaverton, OR 97005-3300
Other practice location 1
4545 E Chandler Blvd Ste 308
Phoenix, AZ 85048-7646
Phone (480) 626-7584
Other providers in Beaverton, OR
- Michael Patrick Collins
- Seth Colner
- Lise Colucci
- Columbia Care LLC
- Hannah Colver
- Judith C. Colwell
- Wayne Ellsworth Colwell
- Rachel Ann Comingore
- Community Access Services II, Inc.
- Community Access Services II, Inc.
All providers in Beaverton, OR · Psychiatric/Mental Health Nurse Practitioner in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.