Kisca Kay Merryman, QMHA-R

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

NO.23-QMHA-R-3693 Issued in OR

Practice address

2045 Silverton Rd NE Ste B
Salem, OR 97301-0100

Phone

(503) 588-5351

Fax

(503) 361-2666

NPI assigned

Mar 14, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Marion County

  • Adult Mental Health Clinic/Center
  • Salem, OR
  • NPI 1528147782
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1497330187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 OAK ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973014019",
            "telephone_number": "503-585-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2045 SILVERTON RD NE STE B",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973010100",
            "telephone_number": "503-588-5351",
            "fax_number": "503-361-2666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERRYMAN",
        "first_name": "KISCA",
        "middle_name": "KAY",
        "credential": "QMHA-R",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-14",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "104611",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OR",
            "license": "NO.23-QMHA-R-3693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Dawn Merrell
• Makenna Ann Merriss
• Cody Wayne Merritt
• Krista Kay Merrow, RDH
• Andrea P Merryman
• Katie Mersinger, RDN
• Julie Lynn Mertes, LCSW, CADC I
• Edgar Merzenich, D.M.D.
• Celina A Mesa, M.S ED, M.P.H
• John Messer, MD

• Case Manager/Care Coordinator in Salem, OR
• Providers in Salem, OR by specialty
• Case Manager/Care Coordinator in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.