Kelsey Marie Merritt

Key facts

NPI

1154844967

Entity type

Individual (NPI type 1)

Primary specialty

Student in an Organized Health Care Education/Training Program 390200000X

License

PSI33163 (FL)

Practice address

12901 Bruce B Downs Blvd
Tampa, FL 33612-4742

Phone

(813) 610-2065

NPI assigned

Jul 24, 2017

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 24, 2017.

{
    "created_epoch": "1500854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1500854400000",
    "number": "1154844967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15302 LAKE MAURINE DR",
            "city": "ODESSA",
            "state": "FL",
            "postal_code": "335563112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12901 BRUCE B DOWNS BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336124742",
            "telephone_number": "813-610-2065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERRITT",
        "first_name": "KELSEY",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-24",
        "last_updated": "2017-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "PSI33163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

• Sylvia Merly, OTR/L
• Julie L Mernaugh, LMHC
• Dorinda Marie Merritt Kampmann
• Bryan R Merritt, M.D.
• John Lawrence Merritt
• Raymond Lee Merritt, DO
• Scott Simpson Eugene Merritt, MD
• Theata Jeanne Merritt, NURSE PRACTITIONER
• Alyssa Merryman
• John Joseph Mertzlufft, O.D.

All providers in Tampa, FL · Student in an Organized Health Care Education/Training Program in Florida