Active NPI
Merilyn Span
- Licensed Vocational Nurse
- Fort Worth, TX
National Provider Identifier
1124435052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Vocational Nurse
- License
- 105667
- Practice address
- 1101 S Main St
Suite 1350
Fort Worth, TX 76104-4802 - Phone
- (817) 321-5450
- Fax
- (817) 321-5451
- NPI assigned
- Jul 11, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 105667 | TX | Primary |
Addresses
Primary practice location
1101 S Main St
Suite 1350
Fort Worth, TX 76104-4802
Mailing address
1101 S Main
Suite 350
Fort, TX 76104
Phone (817) 321-5450
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105667 | TX | MD | Licensed Vocational Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405036800000",
"number": "1124435052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1101 S MAIN",
"address_2": "SUITE 350",
"city": "FORT",
"state": "TX",
"postal_code": "76104",
"telephone_number": "817-321-5450",
"fax_number": "817-321-5451"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 S MAIN ST",
"address_2": "SUITE 1350",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761044802",
"telephone_number": "817-321-5450",
"fax_number": "817-321-5451"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPAN",
"first_name": "MERILYN",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-11",
"last_updated": "2014-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "TX",
"license": "105667",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.