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

Mr. Brandt Derrickson, ATC

Individual provider Athletic Trainer · NPI 1932650736

Mr. Brandt Derrickson, ATC is an Athletic Trainer in Bolivar, Missouri. Licensed in Missouri. Registered with an NPI since 2016.

Licensed in
MO
In the registry since
2016
What do these letters mean?
ATC — Certified Athletic Trainer
Prevents and treats sport and activity injuries.

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Practice location Address checks out

1155 W Parkview St Ste 2D
Bolivar, MO 65613-7800
Phone: (417) 777-2663
Fax: (417) 326-2666
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Athletic Trainer (primary) Taxonomy 2255A2300X · Licence 2016004534 (MO)

Record details

NPI number1932650736
Entity typeIndividual (Type 1)
GenderMale
Credentials ATC
Sole proprietorNo
NPI enumeratedOctober 18, 2016
Last updated in NPPESOctober 18, 2016

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