Provider Demographics
NPI:1609145242
Name:MERRIFIELD, LAKYN ALLISON (PA-C)
Entity Type:Individual
Prefix:
First Name:LAKYN
Middle Name:ALLISON
Last Name:MERRIFIELD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAKYN
Other - Middle Name:
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:400 MATTHEW ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1644
Practice Address - Country:US
Practice Address - Phone:740-568-5207
Practice Address - Fax:740-568-5297
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003487363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1092670OtherNCCPA CERTIFICATION NUMBER
OHP01534303OtherRAILROAD MEDICARE - MHCPI
OH0073178Medicaid
OHH081322Medicare PIN
OHH081321Medicare PIN