Healthcare Provider Details

I. General information

NPI: 1265131213
Provider Name (Legal Business Name): JAMES MERRITT PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 SKOKIE BLVD STE 300
NORTHBROOK IL
60062-4023
US

IV. Provider business mailing address

1850 SAWGRASS ST
VERNON HILLS IL
60061-4576
US

V. Phone/Fax

Practice location:
  • Phone: 224-202-6260
  • Fax:
Mailing address:
  • Phone: 773-910-2281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209036494
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: