Healthcare Provider Details

I. General information

NPI: 1275496184
Provider Name (Legal Business Name): MS. MIKAYLA R MERITHEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 E TOWNLINE 16 RD
PINCONNING MI
48650-8998
US

IV. Provider business mailing address

261 E TOWNLINE 16 RD
PINCONNING MI
48650-8998
US

V. Phone/Fax

Practice location:
  • Phone: 989-359-9380
  • Fax:
Mailing address:
  • Phone: 989-359-9380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: