Active NPI
Delores A. Vandergrift, FNP
- Family Nurse Practitioner
- Carthage, MO
National Provider Identifier
1790723260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 079678
- Practice address
- 2425 Fairlawn Dr
Carthage, MO 64836-3517 - Phone
- (417) 237-0604
- Fax
- (417) 237-0613
- NPI assigned
- Jun 4, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 079678 | MO | Primary |
Addresses
Primary practice location
2425 Fairlawn Dr
Carthage, MO 64836-3517
Mailing address
2425 Fairlawn Dr
Carthage, MO 64836-3517
Phone (417) 237-0604
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790723260 | Medicaid | MO |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Health Center of Joplin Inc | Past | Accepting new patients | |
| Nevada Urgent Care | Past | Accepting new patients | |
| Sjmgroup | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Joplin, MO
- NPI 1043202906
-
- Clinic/Center
- Nevada, MO
- NPI 1902096308
-
- Endocrinology, Diabetes & Metabolism Physician
- Englewood, CO
- NPI 1376590034
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416355200000",
"number": "1790723260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2425 FAIRLAWN DR",
"city": "CARTHAGE",
"state": "MO",
"postal_code": "648363517",
"telephone_number": "417-237-0604",
"fax_number": "417-237-0613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2425 FAIRLAWN DR",
"city": "CARTHAGE",
"state": "MO",
"postal_code": "648363517",
"telephone_number": "417-237-0604",
"fax_number": "417-237-0613"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDERGRIFT",
"first_name": "DELORES",
"middle_name": "A.",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-04",
"last_updated": "2014-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MO",
"license": "079678",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1790723260",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Carthage, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.