Ms Susan M Derivas, CNP | |
4055 E Blueberry St, Meridian, ID 83642-8261 | |
(208) 775-7418 | |
(208) 647-5008 |
Full Name | Ms Susan M Derivas |
---|---|
Gender | Female |
Speciality | Nurse Practitioner - Psychiatric/mental Health |
Location | 4055 E Blueberry St, Meridian, Idaho |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1851493829 | NPI | - | NPPES |
208-775-7418 | Other | SPRUCE HEALTH | |
1032026 | Medicaid | ID | |
5708247 | Other | ID | EVERNORTH |
932434 | Other | AVAILITY ID | |
0062-0104069 | Other | UNITED HEALTHCARE SERVICES, PROVIDER NO. | |
13961493 | Other | CAQH PROVIDER ID | |
909072 | Other | CHANGE HEALTHCARE SUBMITTER ID | |
1851493829 | Other | CLOZAPINE REMS CERTIFIED | |
396453 | Other | MASTER BILLING ID (OSMIND) |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 64266 (Idaho) | Primary |
Entity Name | Telemental Health Link Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1437783529 PECOS PAC ID: 4587062336 Enrollment ID: O20211007002826 |
Mailing Address | Practice Location Address |
---|---|
Ms Susan M Derivas, CNP 4055 E Blueberry St, Meridian, ID 83642-8261 Ph: (208) 775-7418 | Ms Susan M Derivas, CNP 4055 E Blueberry St, Meridian, ID 83642-8261 Ph: (208) 775-7418 |
Jennifer Lytle, FNP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3280 E Lanark Dr, Meridian, ID 83642 Phone: 208-895-8670 Fax: 208-955-0494 | |
Rachael Marie Knuteson, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1948 S Eagle Rd, Meridian, ID 83642 Phone: 208-322-7900 | |
Heidi Ann Fanslow, PMHNP-BC Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 6830 N Agrarian Ave, Meridian, ID 83646 Phone: 253-951-8331 | |
Josef Mcguire, NP-C Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 3080 E Gentry Way Ste 210, Meridian, ID 83642 Phone: 208-384-9022 | |
Melanie Maltese, FNP-C Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 14 S Baltic Pl, Meridian, ID 83642 Phone: 208-887-4872 | |
Michael Pahang, PMHNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1550 N Crestmont Dr, Meridian, ID 83642 Phone: 208-288-4200 Fax: 208-288-4279 | |
Sarah Cheree Johnson, NP-C Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 3653 N Locust Grove Rd, Meridian, ID 83646 Phone: 208-302-7300 Fax: 208-302-7355 |