Active NPI
Derek John Carlson, RN
- Registered Nurse
- Canandaigua, NY
National Provider Identifier
1922547314
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 703439-1
- Practice address
- 35 North St
Canandaigua, NY 14424-1075 - Phone
- (585) 394-0530
- Fax
- (585) 394-3872
- NPI assigned
- Feb 17, 2017
- Sex
- Male
- 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 | 703439-1 | NY | Primary |
Addresses
Primary practice location
35 North St
Canandaigua, NY 14424-1075
Mailing address
2512 State Route 5 and 20
Stanley, NY 14561-9521
Phone (315) 759-0476
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 |
|---|---|---|---|
| 703439-1 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1487289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487289600000",
"number": "1922547314",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2512 STATE ROUTE 5 AND 20",
"city": "STANLEY",
"state": "NY",
"postal_code": "145619521",
"telephone_number": "315-759-0476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "35 NORTH ST",
"city": "CANANDAIGUA",
"state": "NY",
"postal_code": "144241075",
"telephone_number": "585-394-0530",
"fax_number": "585-394-3872"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "DEREK",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-02-17",
"last_updated": "2017-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "703439-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canandaigua, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.