Provider Demographics
NPI:1558726935
Name:MERRILL, AMY (NP-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MERRILL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:AL
Mailing Address - Zip Code:36274-1729
Mailing Address - Country:US
Mailing Address - Phone:334-710-0470
Mailing Address - Fax:
Practice Address - Street 1:109 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:AL
Practice Address - Zip Code:36274-1729
Practice Address - Country:US
Practice Address - Phone:334-710-0470
Practice Address - Fax:334-710-0469
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN 139259363LA2200X
AL1-086045363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health