Provider Demographics
NPI:1073733036
Name:MERRIMAN, 0SUSAN KELLY (RN)
Entity Type:Individual
Prefix:
First Name:0SUSAN
Middle Name:KELLY
Last Name:MERRIMAN
Suffix:
Gender:F
Credentials:RN
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 132
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327-0132
Mailing Address - Country:US
Mailing Address - Phone:423-949-3619
Mailing Address - Fax:
Practice Address - Street 1:170 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327-3710
Practice Address - Country:US
Practice Address - Phone:423-949-3619
Practice Address - Fax:423-949-6507
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000057976163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health