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

Mary K Derlacki, FNP

Individual provider Family Nurse Practitioner · NPI 1609947431

Mary K Derlacki, FNP is a Nurse Practitioner in Boise, Idaho. Qualified in 1989, 37 years ago. Practices with Pioneer Sports and Pain Center LLC, a 6-clinician group and accepts Medicare assignment. Licensed in Idaho and Oregon.

Years since qualifying
37
Licensed in
ID, OR
In the registry since
2006
Specialties on file
2
What do these letters mean?
FNP — Family Nurse Practitioner
A nurse practitioner who treats patients of all ages, much like a family doctor.

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Practice location Address checks out

2800 W Overland Rd
Boise, ID 83705-3038
Phone: (208) 801-1414
Fax: (208) 207-2866
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Rheumatology Physician (primary) Taxonomy 207RR0500X · Licence 090006104N1 (OR)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 69483 (ID)

Record details

NPI number1609947431
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP
Sole proprietorNo
NPI enumeratedNovember 13, 2006
Last updated in NPPESOctober 17, 2024
Certification dateOctober 17, 2024

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 1989 (37 years in practice)
Group practice Pioneer Sports And Pain Center Llc — 6 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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