Healthcare Provider Details

I. General information

NPI: 1942837786
Provider Name (Legal Business Name): WHITNEY KIAN MERCY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RETREAT AVE STE 900
HARTFORD CT
06106-2553
US

IV. Provider business mailing address

6098 EATON ST
WEST PALM BEACH FL
33411-6416
US

V. Phone/Fax

Practice location:
  • Phone: 860-218-2245
  • Fax:
Mailing address:
  • Phone: 561-352-7232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9334023
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11007012
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number12.008878
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: