Individual provider Active NPI

Kenyatta Merriweather, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Loganville, GA
National Provider Identifier
1619228558
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
RN224477 Issued in GA
Practice address
367 Athens Hwy Ste 1800
Loganville, GA 30052-8293
Phone
(770) 554-2999
Fax
(770) 679-6390
NPI assigned
Oct 1, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN224477 GA Primary

Addresses

Primary practice location

367 Athens Hwy Ste 1800
Loganville, GA 30052-8293

Mailing address

367 Athens Hwy Ste 1800
Loganville, GA 30052-8293
Phone (770) 554-2999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, WY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20121107000219 GA Practitioner - Nurse Practitioner 9638320302 Reassigns benefits to 2 organizations
I20200407001208 WY Practitioner - Nurse Practitioner 9638320302 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
May accept Medicare assignment
Group practices
Southwest Counseling ServiceGroup PAC ID 5890777437, 7 clinicians

Practice addresses (Care Compare)

1124 College Dr
Rock Springs, WY 82901-5863
Phone (307) 352-6677

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN224477GAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Counseling Service CurrentSince Mar 11, 2020 Accepting new patients
Advantage Behavioral Health Systems CurrentSince Oct 1, 2015 Accepting new patients
Georgia Mountains Community Services CurrentSince Oct 18, 2014 Accepting new patients
Southwest Counseling Service CurrentSince Mar 11, 2020 Accepting new patients

Locations

250 North Ave
Ofc
Athens, GA 30601
Phone (706) 227-7249

250 Bray St
Athens, GA 30601
Phone (706) 542-9746

250 North Ave
Athens, GA 30601
Phone (706) 542-8656

150A Johnson St
Dahlonega, GA 30533
Phone (706) 864-6822

2300 Foothill Blvd
Rock Springs, WY 82901
Phone (307) 352-6689

1124 College Dr
Rock Springs, WY 82901
Phone (307) 352-6680

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1349049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1619228558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "367 ATHENS HWY STE 1800",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300528293",
            "telephone_number": "770-554-2999",
            "fax_number": "770-679-6390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "367 ATHENS HWY STE 1800",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300528293",
            "telephone_number": "770-554-2999",
            "fax_number": "770-679-6390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERRIWEATHER",
        "first_name": "KENYATTA",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-01",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN224477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loganville, GA

Sources for this page

Verify at the official NPI Registry.