Cody Derby, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AL5128 Issued in FL

Practice address

2301 Lakeland Hills Blvd
Lakeland, FL 33805-2909

Phone

(863) 413-4116

NPI assigned

Jan 29, 2017

Last updated

Jan 27, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Missouri Western State University

  dba Missouri Western State University Sports Medicine

  • Orthopaedic Surgery Physician
  • Saint Joseph, MO
  • NPI 1063891158
  NPD (past)

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

{
    "created_epoch": "1485648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611705600000",
    "number": "1518404557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 LAKELAND HILLS BLVD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338052909",
            "telephone_number": "863-413-4116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 LAKELAND HILLS BLVD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338052909",
            "telephone_number": "863-413-4116"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4525 Downs Dr",
            "address_2": "ATTN: Sports Medicine",
            "address_purpose": "LOCATION",
            "city": "Saint Joseph",
            "state": "MO",
            "postal_code": "645072246",
            "country_code": "US",
            "telephone_number": "816-271-4597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERBY",
        "first_name": "CODY",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-29",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "2017002382",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL5128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison G Denton
• Tony Lawson Denton, H.A.S.
• Cynthia Deokarran, PHARMD
• Mariah Korinna Depass, RMHCI
• Jennifer Depew, DMD
• Pamela Derbyshire, APRN, PMHNP-BC
• Derenees LLC
• Nardin Derias, MD
• Dermatology Associates of Central Florida PA
• Melissa F Deroxtro, LCSW

• Athletic Trainer in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Athletic Trainer in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; 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.