Healthcare Provider Details

I. General information

NPI: 1871482216
Provider Name (Legal Business Name): MERRICK HEID COOLEY PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 09/11/2026
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S LIMESTONE RM 205
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

540 BROOKWATER LN
LEXINGTON KY
40515-6036
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-0567
  • Fax:
Mailing address:
  • Phone: 513-785-8414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberTC046
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberTC046
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC046
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: