Individual provider Active NPI

Carolyn S. Merriman, FNP

  • Family Nurse Practitioner
  • Johnson City, TN
National Provider Identifier
1548488463
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5951 Issued in TN
Practice address
2151 Century Lane
Johnson City, TN 37604
Phone
(423) 926-2500
Fax
(423) 926-5999
NPI assigned
Apr 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5951 TN Primary

Addresses

Primary practice location

2151 Century Lane
Johnson City, TN 37604

Mailing address

365 Stout Drive
Box 70403
Johnson City, TN 37614-1703
Phone (423) 439-4515

Other identifiers 3

IdentifierTypeStateIssuer
66573OtherTNRN LICENSE
5951OtherTNAPN LICENSE
0363530-22OtherANCC

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
5951TNMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1548488463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 STOUT DRIVE",
            "address_2": "BOX 70403",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376141703",
            "telephone_number": "423-439-4515",
            "fax_number": "423-439-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2151 CENTURY LANE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37604",
            "telephone_number": "423-926-2500",
            "fax_number": "423-926-5999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERRIMAN",
        "first_name": "CAROLYN",
        "middle_name": "S.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-23",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "5951",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE",
            "identifier": "66573",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APN LICENSE",
            "identifier": "5951",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANCC",
            "identifier": "0363530-22",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.