Healthcare Provider Details

I. General information

NPI: 1083408942
Provider Name (Legal Business Name): MRS. ERIN MICHELLE MERTENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49497 HIGHWAY 49
ANNAPOLIS MO
63620-7800
US

IV. Provider business mailing address

49497 HIGHWAY 49
ANNAPOLIS MO
63620-7800
US

V. Phone/Fax

Practice location:
  • Phone: 573-307-1766
  • Fax: 573-307-1766
Mailing address:
  • Phone: 573-307-1766
  • Fax: 573-307-1766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: