Kelly Joseph Derrick, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

T0194 Issued in TX

Practice address

4501 Clear Creek Rd
Killeen, TX 76549-4218

Phone

(254) 501-6400

NPI assigned

May 22, 2007

Last updated

Dec 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kderrick1096609@direct.sw.org
• Direct secure messaging: kderrick@landmarkhealth-direct.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northeast Arkansas Clinic, PA

  dba NEA Clinic

  • Multi-Specialty Clinic/Center
  • Jonesboro, AR
  • NPI 1376517177
  NPD (past)

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701907200000",
    "number": "1407065725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 CLEAR CREEK RD",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765494218",
            "telephone_number": "254-501-6400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2901 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Pocahontas",
            "state": "AR",
            "postal_code": "724559438",
            "country_code": "US",
            "telephone_number": "870-892-4468",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6363 N State Highway 161 Ste 100",
            "address_purpose": "LOCATION",
            "city": "Irving",
            "state": "TX",
            "postal_code": "750382239",
            "country_code": "US",
            "telephone_number": "469-200-3272",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERRICK",
        "first_name": "KELLY",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "5489",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "T0194",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-5244",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kderrick1096609@direct.sw.org",
            "affiliation": "N",
            "address_1": "4501 Clear Creek Rd",
            "city": "Killeen",
            "state": "TX",
            "country_code": "US",
            "postal_code": "765494218",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mikayela Cheyenne Delve
• Halle Denkins
• Vivian Lee Dennison, MS, LPC, LCDC
• Dentistry of Brownsville PC (Topaz Dentistry)
• Lisa Denwalt, RN
• Melody J a Desantiago, CPNP
• Abigail Desbois
• Jenae Michele Desoto
• Julius Desoto, BCBA
• Devin Gneiting DMD PLLC (Killeen Dental)

• Family Medicine Physician in Killeen, TX
• Providers in Killeen, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; 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.