Active NPI
Mikel M Merritt, PHD
- Clinical Psychologist
- Randolph Afb, TX
National Provider Identifier
1427158203
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 682
- Practice address
- 359 MDG
221 3Rd St W
Randolph Afb, TX 78150 - Phone
- (210) 652-2448
- NPI assigned
- Sep 22, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 682 | NE | Primary |
Addresses
Primary practice location
359 MDG
221 3Rd St W
Randolph Afb, TX 78150
Mailing address
2729 Socorro Loop Apt B
Holloman Afb, NM 88330-7124
Phone (505) 572-5676
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 682 | NE | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528675200000",
"number": "1427158203",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2729 SOCORRO LOOP APT B",
"city": "HOLLOMAN AFB",
"state": "NM",
"postal_code": "883307124",
"telephone_number": "505-572-5676"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "359 MDG",
"address_2": "221 3RD ST W",
"city": "RANDOLPH AFB",
"state": "TX",
"postal_code": "78150",
"telephone_number": "210-652-2448"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MERRITT",
"first_name": "MIKEL",
"middle_name": "M",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-22",
"last_updated": "2018-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NE",
"license": "682",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Randolph Afb, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.