Healthcare Provider Details

I. General information

NPI: 1982122578
Provider Name (Legal Business Name): MERISSA YVONNE STOOPS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MERISSA MYERS

II. Dates (important events)

Enumeration Date: 09/02/2017
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N SENATE BLVD
INDIANAPOLIS IN
46202-1239
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-0585
  • Fax: 317-962-2082
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-2562
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10003916A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1155930
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60902142
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: