Thomas V Derksen, NP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

731442 Issued in TX

Practice address

6550 Fannin St
Sm1001
Houston, TX 77030-2717

Phone

(713) 441-0005

Fax

(713) 790-6617

NPI assigned

May 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397001600000",
    "number": "1730133026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6550 FANNIN ST",
            "address_2": "SM1001",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302717",
            "telephone_number": "713-441-0005",
            "fax_number": "713-790-6617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6550 FANNIN ST",
            "address_2": "SM1001",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302717",
            "telephone_number": "713-441-0005",
            "fax_number": "713-790-6617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERKSEN",
        "first_name": "THOMAS",
        "middle_name": "V",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2014-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "731442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1730133026",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43983800",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "009000261R",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "214435401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victoria Derdari, NP
• Nina H Dereska, MD
• Jeffery Alan Derhammer
• Heather Derijke, BCBA
• Laura Kathleen Derkacz
• Dermagenix LLC
• Howard Steven Derman, M.D.
• Dermatologic Surgery Center of Houston, P.a.
• Dermatological Association of Texas, PLLC
• Dermatology & Cosmetic Surgery Associates PA

• Acute Care Nurse Practitioner in Houston, TX
• Providers in Houston, TX by specialty
• Acute Care Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2014; 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.