Provider Demographics
NPI:1851076939
Name:MERRICK, KYLE (APRN)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:MERRICK
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3097 W MEADOWBEND DR
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:IN
Mailing Address - Zip Code:46157-8112
Mailing Address - Country:US
Mailing Address - Phone:317-748-8651
Mailing Address - Fax:
Practice Address - Street 1:1051 SOUTHFIELD DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2955
Practice Address - Country:US
Practice Address - Phone:844-991-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71014013A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health