Provider Demographics
NPI:1821130089
Name:MERRITT, AMY E (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:E
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9295 KORNBRUST CIR
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5552
Mailing Address - Country:US
Mailing Address - Phone:985-290-2074
Mailing Address - Fax:
Practice Address - Street 1:1945 LAKEPOINTE DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-6469
Practice Address - Country:US
Practice Address - Phone:143-025-3052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31035207Q00000X, 207R00000X
LA13287R207R00000X
LAMD.13287R208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03303308Medicaid
LA1564974Medicaid
LA5H0877061Medicare PIN
MS03303308Medicaid