Healthcare Provider Details

I. General information

NPI: 1245793413
Provider Name (Legal Business Name): MERCERNPSERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 PREDDY CREEK RD
BARBOURSVILLE VA
22923-2826
US

IV. Provider business mailing address

680 PREDDY CREEK RD
BARBOURSVILLE VA
22923-2826
US

V. Phone/Fax

Practice location:
  • Phone: 434-882-4950
  • Fax:
Mailing address:
  • Phone: 434-882-4950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAVID MERCER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 434-882-4950