Healthcare Provider Details

I. General information

NPI: 1245545235
Provider Name (Legal Business Name): NICOLE LYNN MERRITT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5219 LANKFORD HWY
NEW CHURCH VA
23415-3332
US

IV. Provider business mailing address

20280 MARKET ST
ONANCOCK VA
23417-1331
US

V. Phone/Fax

Practice location:
  • Phone: 757-824-5676
  • Fax: 757-824-5872
Mailing address:
  • Phone: 757-414-0400
  • Fax: 757-414-0569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOT013788
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberH0077515
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102209302
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: