Provider Demographics
NPI:1891739660
Name:MERRITT, TINA KAY (MD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:KAY
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:KAY
Other - Last Name:HATLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1900 S WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-6755
Mailing Address - Country:US
Mailing Address - Phone:479-254-9777
Mailing Address - Fax:479-254-9729
Practice Address - Street 1:1900 S WALTON BLVD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6755
Practice Address - Country:US
Practice Address - Phone:479-254-9777
Practice Address - Fax:479-254-9729
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2999174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149043001Medicaid
AR149043001Medicaid
ARH46471Medicare UPIN