Provider Demographics
NPI:1073150827
Name:MERRITT, MELISSA LEIGH (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEIGH
Last Name:MERRITT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 FREEMAN RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:SC
Mailing Address - Zip Code:29657-9406
Mailing Address - Country:US
Mailing Address - Phone:251-288-8709
Mailing Address - Fax:
Practice Address - Street 1:112 SURGICAL BLVD STE A
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-6654
Practice Address - Country:US
Practice Address - Phone:864-885-0608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily