Basic Information
| Provider Information | |||||||||
| NPI: | 1033648761 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERRIAM | ||||||||
| FirstName: | JANET | ||||||||
| MiddleName: | KIKILY | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 CHERITA LN | ||||||||
| Address2: | |||||||||
| City: | HARVEST | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357498033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563377810 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 WAYNE RD NW | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358063567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562883333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2017 | ||||||||
| LastUpdateDate: | 06/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 1-110124 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.