Active NPI
Derwent O Daniel, NP
- Gerontology Nurse Practitioner
- West Blocton, AL
National Provider Identifier
1467573618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- Practice address
- 345 Magnolia Street
West Blocton, AL 35184 - Phone
- (205) 938-9508
- Fax
- (205) 938-9550
- NPI assigned
- Apr 3, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | TN | Primary |
Addresses
Primary practice location
345 Magnolia Street
West Blocton, AL 35184
Mailing address
2731 MLK Jr Blvd
Tuscaloosa, AL 35401-5235
Phone (205) 349-3250
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 |
|---|---|---|---|
| 0258909-23 | TN | MD | Gerontology Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1467573618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2731 MLK JR BLVD",
"city": "TUSCALOOSA",
"state": "AL",
"postal_code": "354015235",
"telephone_number": "205-349-3250",
"fax_number": "205-345-3993"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "345 MAGNOLIA STREET",
"city": "WEST BLOCTON",
"state": "AL",
"postal_code": "35184",
"telephone_number": "205-938-9508",
"fax_number": "205-938-9550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DANIEL",
"first_name": "DERWENT",
"middle_name": "O",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "TN",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Blocton, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.