Kati M Derevere, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

CNP111084 Issued in ME

Practice address

1049 Main Street
Unit 2S
Mount Desert, ME 04660

Phone

(207) 244-4111

Fax

(207) 244-4114

NPI assigned

Aug 3, 2011

Last updated

Dec 16, 2014By the provider in NPPES

Sex

Female

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

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Health Affiliates Maine, LLCGroup PAC ID 1951594076, 169 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Health Affiliates Maine, LLC

  • Community/Behavioral Health Agency
  • Auburn, ME
  • NPI 1932413556
  Medicare reassignment Care Compare group NPD
• Konalife, LLC, PA

  • Psychiatric/Mental Health Nurse Practitioner
  • Mount Desert, ME
  • NPI 1457291619
  NPD Authorized official

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

{
    "created_epoch": "1312329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418688000000",
    "number": "1861770166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 687",
            "city": "MOUNT DESERT",
            "state": "ME",
            "postal_code": "046600687",
            "telephone_number": "207-244-4111",
            "fax_number": "207-244-4114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1049 MAIN STREET",
            "address_2": "UNIT 2S",
            "city": "MOUNT DESERT",
            "state": "ME",
            "postal_code": "04660",
            "telephone_number": "207-244-4111",
            "fax_number": "207-244-4114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEREVERE",
        "first_name": "KATI",
        "middle_name": "M",
        "name_prefix": "Miss",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-03",
        "last_updated": "2014-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ME",
            "license": "CNP111084",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "ME",
            "license": "RO49940",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Acadia Integrative Medicine and Primary Care PC
• Acadia Psychiatry PLLC
• Coastal Family Services
• Eyes, P.a.
• Jessica Ann Greenbaum, LMT
• Eliza S Homer, PHD, LCPC, ATR-BC
• Georgia Manning Howland
• Daniel Johnson, PHD, LCPC

• Psychiatric/Mental Health Nurse Practitioner in Mount Desert, ME
• Providers in Mount Desert, ME by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.