Healthcare Provider Details

I. General information

NPI: 1235578261
Provider Name (Legal Business Name): TAMMY LYNN MERSON MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MARKET ST OFC 3
DENTON MD
21629-1035
US

IV. Provider business mailing address

14955 GREENSBORO RD
GOLDSBORO MD
21636-1311
US

V. Phone/Fax

Practice location:
  • Phone: 410-656-1541
  • Fax: 854-400-4919
Mailing address:
  • Phone: 410-924-7360
  • Fax: 854-400-4919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR129055
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR129055
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: