Individual
KELLY MARIE DERGANC
Active
Individual
KELLY MARIE DERGANC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
141458
KS
363LA2200X
Adult Health Nurse Practitioner
Primary
2012035666
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068002116
MEDICARE PTAN
KS
05
—
200674390B
—
KS
Enumeration date
08/26/2010
Last updated
06/14/2022
Update your record
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