Vanessa Lynn Derner, LAT, ATC, ACSM-EP

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

ATR-009312 Issued in AZ

Practice address

2020 S Avenue 8 E
Yuma, AZ 85365-6900

Phone

(402) 672-6025

NPI assigned

Aug 7, 2020

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1596758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678838400000",
    "number": "1962012575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 EAGLE VIEW DR",
            "city": "PAPILLION",
            "state": "NE",
            "postal_code": "681332482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 S AVENUE 8 E",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853656900",
            "telephone_number": "402-672-6025"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "710 Eagle View Dr",
            "address_purpose": "LOCATION",
            "city": "Papillion",
            "state": "NE",
            "postal_code": "681332482",
            "country_code": "US",
            "telephone_number": "402-672-6025",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3061 S Melanie Dr",
            "address_purpose": "LOCATION",
            "city": "Yuma",
            "state": "AZ",
            "postal_code": "853655112",
            "country_code": "US",
            "telephone_number": "402-672-6025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERNER",
        "first_name": "VANESSA",
        "middle_name": "LYNN",
        "credential": "LAT, ATC, ACSM-EP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-07",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AZ",
            "license": "ATR-009312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Yuma, AZ
• Providers in Yuma, AZ by specialty
• Athletic Trainer in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.