Provider Demographics
NPI:1952081556
Name:MERRELL, MARY CHRISTINE (FNP-BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CHRISTINE
Last Name:MERRELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 S WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-3515
Mailing Address - Country:US
Mailing Address - Phone:479-220-2341
Mailing Address - Fax:
Practice Address - Street 1:413 S WRIGHT ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3515
Practice Address - Country:US
Practice Address - Phone:479-220-2341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2023060388363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily