Active NPI
Kimberly Derque, BCBA
- Behavior Analyst
- Saint Peters, MO
National Provider Identifier
1902791973
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 894991
- Practice address
- 1421 Triad Center Dr
Saint Peters, MO 63376-7357 - Phone
- (636) 248-7841
- NPI assigned
- Jun 10, 2025
- 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 |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 894991 | MO | Primary |
Addresses
Primary practice location
1421 Triad Center Dr
Saint Peters, MO 63376-7357
Mailing address
4848 Daltrey CT
Saint Louis, MO 63129-1655
Phone (636) 524-2136
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 894991 | MO | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1749513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749513600000",
"number": "1902791973",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4848 DALTREY CT",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631291655",
"telephone_number": "636-524-2136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1421 TRIAD CENTER DR",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "633767357",
"telephone_number": "636-248-7841"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERQUE",
"first_name": "KIMBERLY",
"credential": "BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-06-10",
"last_updated": "2025-06-10",
"certification_date": "2025-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MO",
"license": "894991",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Peters, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.