Provider Demographics
NPI:1376297572
Name:DEROCHE, KAIA ELAINE (DNP)
Entity Type:Individual
Prefix:
First Name:KAIA
Middle Name:ELAINE
Last Name:DEROCHE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 HOLMES CREEK LN
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4404
Mailing Address - Country:US
Mailing Address - Phone:970-930-2207
Mailing Address - Fax:
Practice Address - Street 1:123 HOLMES CREEK LN
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4404
Practice Address - Country:US
Practice Address - Phone:970-930-2207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10004843363LF0000X
CARN95240413163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice