Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 11012899 | FL |
NPI | 1013307446 |
---|---|
Provider Name | Katesha M. Merriex |
First Address | Gainesville, FL 32641-2783 |
Second Address | Gainesville, FL 32608-4006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2015 |
Last Update Date | 04/05/2021 |