Provider Demographics
NPI:1760031033
Name:MERRITT, VERONICA DENISE
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:DENISE
Last Name:MERRITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:DENISE
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1985 LONG CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-8471
Mailing Address - Country:US
Mailing Address - Phone:601-483-8037
Mailing Address - Fax:
Practice Address - Street 1:1985 LONG CREEK RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-8471
Practice Address - Country:US
Practice Address - Phone:601-483-8037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider