Provider Demographics
NPI:1497232458
Name:ORR, MERSADIES BERLYNN
Entity Type:Individual
Prefix:
First Name:MERSADIES
Middle Name:BERLYNN
Last Name:ORR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 STACKYARD RD
Mailing Address - Street 2:
Mailing Address - City:FALKVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35622-9706
Mailing Address - Country:US
Mailing Address - Phone:256-606-9109
Mailing Address - Fax:
Practice Address - Street 1:3485 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-5603
Practice Address - Country:US
Practice Address - Phone:205-930-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF06182531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily