Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 1-110124 | AL |
NPI | 1033648761 |
---|---|
Provider Name | Janet Kikily Merriam |
First Address | Harvest, AL 35749-8033 |
Second Address | Huntsville, AL 35806-3567 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2017 |
Last Update Date | 06/06/2017 |