Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Derrick Kyle Pelton, NP

Individual provider Family Nurse Practitioner · NPI 1609208354

Derrick Kyle Pelton, NP is a Nurse Practitioner in Santa Rosa, California. Qualified in 2013, 13 years ago. Practices with Sutter Bay Medical Foundation, a 3,762-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
13
Licensed in
CA
In the registry since
2013
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

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Practice location Address checks out

3883 Airway Dr Ste 120
Santa Rosa, CA 95403-1678
Phone: (707) 521-4495
Fax: (707) 573-5421
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 95012148 (CA)

Record details

NPI number1609208354
Entity typeIndividual (Type 1)
GenderMale
Credentials NP
Sole proprietorNo
NPI enumeratedAugust 5, 2013
Last updated in NPPESFebruary 9, 2022
Certification dateFebruary 9, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Sutter Bay Medical Foundation — 3762 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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