Healthcare Provider Details

I. General information

NPI: 1124691191
Provider Name (Legal Business Name): KIARA DIONTEA MERCHANT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 HART ST
CANTON MS
39046-4805
US

IV. Provider business mailing address

624 S SECOND ST
BROOKHAVEN MS
39601-3941
US

V. Phone/Fax

Practice location:
  • Phone: 601-859-9888
  • Fax:
Mailing address:
  • Phone: 601-669-7357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904301
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number901425
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: