MR. DEREK BRENT KORDENBROCK NP NPI 1245579408

NPI Information

NPI: 1245579408
Provider Name: MR. DEREK BRENT KORDENBROCK, NP
Classification: Nurse Practitioner - 363LA2200X
Entity Type: Individual

Specialization: Adult Health

PECOS Registration: Yes

Address:
1345 CENTER DR UNIT A
MEDFORD, OR
ZIP 97501
Phone: (541) 734-9030
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MR. Derek Brent Kordenbrock, NP is an adult health nurse practitioner in Medford, OR with 12 years of experience. MR. Derek Brent Kordenbrock, NP NPI is 1245579408. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO SCHOOL OF MEDICINE
Graduation Year:2012

The provider's business location address is:

1345 CENTER DR UNIT A
MEDFORD, OR
ZIP 97501-945
Phone: (541) 734-9030
Fax: (541) 734-9885

The NPI 1245579408 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/7/2013 and was last updated on 3/20/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2200X	Nurse Practitioner	Adult Health	22446	CALIFORNIA	No
2	363LX0106X	Nurse Practitioner	Occupational Health	201604376NP-PP	OREGON	No
3	363LX0106X	Nurse Practitioner	Occupational Health	22446	CALIFORNIA	No
4	363LA2200X	Nurse Practitioner	Adult Health	201604376NP-PP	OREGON	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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