MEDICARE: KELLY RENEE MERRICK MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1427678499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY RENEE MERRICK MSW

Provider Business Mailing Address
First Line	:	8600 S OLIE AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9324
Country	:	US
Telephone Number	:	405-227-9965
Fax Number	:

Provider Business Practice Location Address
First Line	:	7817 SW 87TH CIR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73169-7800
Country	:	US
Telephone Number	:	405-227-9864
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2020
Last Update Date	:	04/20/2020

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