| 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 | Meridian Advanced Psychiatry , Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1609412683 PECOS PAC ID: 8628490711 Enrollment ID: O20200618000604 |
| 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: 1526 W Ustick Rd Ste 110, Meridian, ID 83646 Phone: 208-370-5888 | |
Rachael Marie Knuteson, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1948 S Eagle Rd, Meridian, ID 83642 Phone: 208-322-7900 | |
Heidi Ann Fanslow, PMHNP-BC Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 6830 N Agrarian Ave, Meridian, ID 83646 Phone: 253-951-8331 | |
Josef Mcguire, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3080 E Gentry Way Ste 210, Meridian, ID 83642 Phone: 208-384-9022 | |
Melanie Maltese, FNP-C Nurse Practitioner Medicare: Accepting Medicare Assignments 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: Accepting Medicare Assignments Practice Location: 3653 N Locust Grove Rd, Meridian, ID 83646 Phone: 208-302-7300 Fax: 208-302-7355 |