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

Kristen Alice Derderian, CNP

Individual provider Primary Care Nurse Practitioner · NPI 1407417645

Kristen Alice Derderian, CNP is a Nurse Practitioner in Saint Louis, Missouri. Qualified in 2019, 7 years ago. Practices with Mass General Brigham Community Physicians Inc, a 422-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Massachusetts and Missouri.

Years since qualifying
7
Licensed in
MA, MO
In the registry since
2019
Specialties on file
2
What do these letters mean?
CNP — Certified Nurse Practitioner
A certified nurse practitioner.

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Practice location Address checks out

12200 Weber Hill Rd Ste 100
Saint Louis, MO 63127-1599
Phone: (314) 698-2500
Fax: (314) 698-2323
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Primary Care Nurse Practitioner (primary) Taxonomy 363LP2300X · Licence 2021013574 (MO)
Primary Care Nurse Practitioner Taxonomy 363LP2300X · Licence RN2321686 (MA)

Record details

NPI number1407417645
Entity typeIndividual (Type 1)
GenderFemale
Credentials CNP
Sole proprietorNo
NPI enumeratedJune 27, 2019
Last updated in NPPESMarch 21, 2022
Certification dateMarch 21, 2022

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Mass General Brigham Community Physicians Inc — 422 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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