MEDICARE: JORDAN KAITLYN MERRELS MD

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	2084P0800X	Psychiatry Physician	84531	SC

General Provider Information

NPI Number	:	1447877014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN KAITLYN MERRELS MD

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE FL 4
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2842
Country	:	US
Telephone Number	:	803-434-1433
Fax Number	:	803-434-4062

Provider Business Practice Location Address
First Line	:	300 E MCBEE AVE FL 4
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2842
Country	:	US
Telephone Number	:	803-434-1433
Fax Number	:	803-434-4062

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

Provider Enumeration Date	:	06/30/2020
Last Update Date	:	05/28/2026

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