MRS. KATELYN DEADERICK APRN, FNP-C
NPI 1639892755
Nurse Practitioner - Family in Fort Leonard Wood, MO
About Mrs. Katelyn Deaderick Aprn, Fnp-c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MRS. KATELYN DEADERICK APRN, FNP-C (NPI 1639892755) is an individual family provider in Fort Leonard Wood, Missouri, licensed in Florida (APRN11024131) and active in the NPI registry since September 2022. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mrs. Katelyn Deaderick Aprn, Fnp-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Katelyn Deaderick reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Sarasota, FL 34239
- Reassigned Medicare billing, Florida enrollment
- 8 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 65473 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
FORT LEONARD WOOD, MO 65473
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Katelyn Deaderick's NPI number?
The NPI number for Katelyn Deaderick is 1639892755. It was assigned to this individual provider in the NPPES registry on September 23, 2022.
Where is Katelyn Deaderick located?
Katelyn Deaderick practices at 4430 Missouri Ave, Fort Leonard Wood, MO 65473. The listed phone number is (573) 596-1765.
What is Katelyn Deaderick's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Katelyn Deaderick enrolled in Medicare?
Yes. Katelyn Deaderick is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Katelyn Deaderick's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Katelyn Deaderick reassigns Medicare benefits to Medpeds Associates Of Sarasota (Sarasota, FL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Katelyn Deaderick's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Katelyn Deaderick was last updated on December 17, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mrs. Katelyn Deaderick, APRN, FNP-C · NPI 1639892755
Family physician in Fort Leonard Wood, Missouri. Individual provider, active in the CMS NPPES registry since September 23, 2022.
## Identity
- **NPI:** 1639892755 (Entity type: Individual)
- **Enumerated:** September 23, 2022
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** APRN11024131 (Florida)
- **Sole proprietor:** No
## Practice location
- **Address:** 4430 MISSOURI AVE, Fort Leonard Wood, MO 65473-9098
- **Phone:** (573) 596-1765
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Medpeds Associates Of Sarasota (NPI 1053315572, Sarasota, FL), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 17, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1639892755) · Data from the CMS NPPES public registry.