=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780406579
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGORY ARTHUR MERCIER DNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2024
-----------------------------------------------------
Last Update Date | 10/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 819 W MAIN ST
-----------------------------------------------------
City | CENTRE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35960-1235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-266-1021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 970 COUNTY ROAD 112
-----------------------------------------------------
City | CENTRE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35960-7009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-275-1295
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1-201079
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------