Provider Demographics
NPI:1215930748
Name:MCDERMOTT, JOHN PATRICK (FNP, PA-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PATRICK
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:FNP, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E WALKER ST STE A
Mailing Address - Street 2:
Mailing Address - City:ORLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95963-2222
Mailing Address - Country:US
Mailing Address - Phone:530-865-4400
Mailing Address - Fax:530-865-7285
Practice Address - Street 1:750 E WALKER ST STE A
Practice Address - Street 2:
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963-2222
Practice Address - Country:US
Practice Address - Phone:530-865-4400
Practice Address - Fax:530-865-7285
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 547631163W00000X
CAPHN 60273163WC1500X
CAPA17515363A00000X
CANP15241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant