1356623953 NPI number — KATHY DAWN MERRILL RN, FNP-BC, CDE

Table of content: KATHY DAWN MERRILL RN, FNP-BC, CDE (NPI 1356623953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356623953 NPI number — KATHY DAWN MERRILL RN, FNP-BC, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERRILL
Provider First Name:
KATHY
Provider Middle Name:
DAWN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, FNP-BC, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356623953
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2017 STATE ROUTE 821 # B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45750-5466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-373-1944
Provider Business Mailing Address Fax Number:
740-373-1910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2017 STATE ROUTE 821 # B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45750-5466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-373-1944
Provider Business Practice Location Address Fax Number:
740-373-1910
Provider Enumeration Date:
09/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN334636 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 75070 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: COA12818-NP , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3810024552 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0057359 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01430427 . This is a "RAILROAD MEDICARE - MHCPI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com