Basic Information
| Provider Information | |||||||||
| NPI: | 1912363755 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDERMID | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | KENT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | AG-ACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 880222 | ||||||||
| Address2: | |||||||||
| City: | STEAMBOAT SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804880222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039174739 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 705 MARKETPLACE PLZ STE 200 | ||||||||
| Address2: | |||||||||
| City: | STEAMBOAT SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804871841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708796663 | ||||||||
| FaxNumber: | 9708711234 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2016 | ||||||||
| LastUpdateDate: | 05/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | APN.0992159-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.