Provider Demographics
NPI:1023372422
Name:MERRITT, AMY NICOLE (FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:MERRITT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4708 ALLIANCE BLVD
Mailing Address - Street 2:PAVILION I, SUITE 600
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5340
Mailing Address - Country:US
Mailing Address - Phone:469-467-0011
Mailing Address - Fax:469-467-4923
Practice Address - Street 1:4708 ALLIANCE BLVD
Practice Address - Street 2:PAVILION I, SUITE 600
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5340
Practice Address - Country:US
Practice Address - Phone:469-467-0011
Practice Address - Fax:469-467-4923
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX744100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX306776101Medicaid
TXP01153118Medicare PIN
TX306776101Medicaid