Healthcare Provider Details

I. General information

NPI: 1851076939
Provider Name (Legal Business Name): KYLE MERRICK APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 SOUTHFIELD DR
PLAINFIELD IN
46168-2955
US

IV. Provider business mailing address

3097 W MEADOWBEND DR
MONROVIA IN
46157-8112
US

V. Phone/Fax

Practice location:
  • Phone: 844-991-9900
  • Fax:
Mailing address:
  • Phone: 317-748-8651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71014013A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: