MEDICARE: KORI NICOLE MERRIMAN MA, BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104398544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KORI NICOLE MERRIMAN MA, BCBA

Provider Business Mailing Address
First Line	:	5216 4TH AVENUE CIR E
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34208-5621
Country	:	US
Telephone Number	:	941-744-1211
Fax Number	:	961-666-7419

Provider Business Practice Location Address
First Line	:	4442 5TH ST W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34207-1531
Country	:	US
Telephone Number	:	941-744-1211
Fax Number	:	941-666-7419

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2018
Last Update Date	:	03/11/2024

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