Provider Demographics
NPI:1134730542
Name:MERRITT, TAYLOR CHAMPION
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:CHAMPION
Last Name:MERRITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11940 BRICKSOME AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2594
Mailing Address - Country:US
Mailing Address - Phone:225-250-5829
Mailing Address - Fax:225-250-5879
Practice Address - Street 1:11940 BRICKSOME AVE STE C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2594
Practice Address - Country:US
Practice Address - Phone:225-250-5829
Practice Address - Fax:225-250-5879
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator