Provider Demographics
NPI:1700450954
Name:MERCER, KORTNEY (MA,ERT,PCT)
Entity Type:Individual
Prefix:
First Name:KORTNEY
Middle Name:
Last Name:MERCER
Suffix:
Gender:F
Credentials:MA,ERT,PCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 251242
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-1242
Mailing Address - Country:US
Mailing Address - Phone:248-254-2372
Mailing Address - Fax:
Practice Address - Street 1:251242 DALY RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48325
Practice Address - Country:US
Practice Address - Phone:248-254-2372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146N00000X, 156F00000X
MI156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic