Provider Demographics
NPI:1982122578
Name:STOOPS, MERISSA YVONNE (PA-C)
Entity Type:Individual
Prefix:
First Name:MERISSA
Middle Name:YVONNE
Last Name:STOOPS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MERISSA
Other - Middle Name:
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 N SENATE BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1239
Practice Address - Country:US
Practice Address - Phone:317-962-0585
Practice Address - Fax:317-962-2082
Is Sole Proprietor?:No
Enumeration Date:2017-09-02
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-2562363A00000X
IN10003916A363A00000X
WA1155930363A00000X
WAPA60902142363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN233690175OtherMEDICARE