Provider Demographics
NPI:1619782737
Name:SKAGGS, DERICK JON (PROGRAM MANAGER SCC)
Entity type:Individual
Prefix:
First Name:DERICK
Middle Name:JON
Last Name:SKAGGS
Suffix:
Gender:M
Credentials:PROGRAM MANAGER SCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7382 HALITE CT
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-3023
Mailing Address - Country:US
Mailing Address - Phone:719-452-9190
Mailing Address - Fax:
Practice Address - Street 1:7382 HALITE CT
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-3023
Practice Address - Country:US
Practice Address - Phone:719-452-9190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist