Healthcare Provider Details

I. General information

NPI: 1992843809
Provider Name (Legal Business Name): NANCY CHRISTENE MERRITT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WALL ST
POTEAU OK
74953-4405
US

IV. Provider business mailing address

105 WALL ST
POTEAU OK
74953-4433
US

V. Phone/Fax

Practice location:
  • Phone: 918-635-3545
  • Fax: 918-635-3516
Mailing address:
  • Phone: 918-635-3566
  • Fax: 918-635-3568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4429
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4429
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: