Active NPI
Deidra McCullough, RN
- Registered Nurse
- Moraine, OH
National Provider Identifier
1861010068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN.303072
- Practice address
- 200 Daruma Pkwy
Moraine, OH 45439-7909 - Phone
- (937) 963-5512
- Fax
- (937) 496-5274
- NPI assigned
- Jul 14, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN.303072 | OH | Primary |
Addresses
Primary practice location
200 Daruma Pkwy
Moraine, OH 45439-7909
Mailing address
6692 Shull Rd
Dayton, OH 45424-1223
Phone (937) 516-8662
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)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN.303072 | OH | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594684800000",
"number": "1861010068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6692 SHULL RD",
"city": "DAYTON",
"state": "OH",
"postal_code": "454241223",
"telephone_number": "937-516-8662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 DARUMA PKWY",
"city": "MORAINE",
"state": "OH",
"postal_code": "454397909",
"telephone_number": "937-963-5512",
"fax_number": "937-496-5274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCULLOUGH",
"first_name": "DEIDRA",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-14",
"last_updated": "2020-07-14",
"certification_date": "2020-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OH",
"license": "RN.303072",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moraine, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.