| Doctor Name: | JOHN M. DERFELT |
| NPI Number: | 1912377862 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP-C |
| License Number: | 2015035372 |
| Business Practice Address: | 6151 N Main Street Rd Webb City, MO - 648708189 |
| Business Phone Number: | 4177810408 |
| Business Fax Number: | 4175565377 |
| Mailing Address: | Po Box 504944, SAINT LOUIS |
| State: | MO |
| Postal Code: | 631504944 |
| Phone Number: | 8005728606 |
| Fax Number: | 4176244214 |
| NPI Enumeration Date: | 10/05/2015 |
| NPI Last Update Date: | 11/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2015035372 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |