Healthcare Provider Details

I. General information

NPI: 1821456096
Provider Name (Legal Business Name): MELISSA KAYE MERRILL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8424 NAAB RD STE 1H
INDIANAPOLIS IN
46260-1954
US

IV. Provider business mailing address

8424 NAAB RD STE 1H
INDIANAPOLIS IN
46260-1954
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-8680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006505A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: