1891045712 NPI number — DR. CAROLYN MERRITT, PLLC

Table of content: (NPI 1891045712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891045712 NPI number — DR. CAROLYN MERRITT, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. CAROLYN MERRITT, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1891045712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5240
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSHILL
Provider Business Mailing Address State Name:
VI
Provider Business Mailing Address Postal Code:
00851-5240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
340-778-7546
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
254-A ESTATE GLYNN # 3 & 4
Provider Second Line Business Practice Location Address:
RR 1 6198
Provider Business Practice Location Address City Name:
KINGSHILL
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00850-6198
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-778-7546
Provider Business Practice Location Address Fax Number:
340-778-7543
Provider Enumeration Date:
09/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MERRITT
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
LAVON
Authorized Official Title or Position:
PHYSICIAN/ OWNER
Authorized Official Telephone Number:
340-778-7546

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  1247 , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PENDING . This is a "PTAN" identifier . This identifiers is of the category "OTHER".




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