Provider Demographics
NPI:1922798396
Name:DERCHAK, MICHAEL LYNN
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LYNN
Last Name:DERCHAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 FLORENCE ST APT 110
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-0160
Mailing Address - Country:US
Mailing Address - Phone:505-603-6216
Mailing Address - Fax:
Practice Address - Street 1:MISSION HOSPITAL ST. JOSEPH'S CAMPUS
Practice Address - Street 2:428 BILTMORE AVE
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801
Practice Address - Country:US
Practice Address - Phone:828-213-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC5018352363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program