Provider Demographics
NPI:1013204148
Name:MERRITT, CARRIE HALL (PA)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:HALL
Last Name:MERRITT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-766-0547
Mailing Address - Fax:
Practice Address - Street 1:105 STADIUM OAKS DR
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8962
Practice Address - Country:US
Practice Address - Phone:336-766-0547
Practice Address - Fax:366-766-0549
Is Sole Proprietor?:No
Enumeration Date:2011-07-10
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL 1664363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1013204148OtherBCBS
NCNCB656AOtherMEDICARE