| NPI | 1275942401 |
|---|---|
| Former Name | MYSTIE KAROLE DERRICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 18948) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 18948) |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2023-09-13 |