Active NPI
Melissa L Merrick
- Registered Dietitian
- Mora, MN
National Provider Identifier
1831240449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1940
- Practice address
- 301 Highway 65 S
Mora, MN 55051-1899 - Phone
- (320) 225-3640
- NPI assigned
- Jan 12, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1940 | MN | Primary |
Addresses
Primary practice location
301 Highway 65 S
Mora, MN 55051-1899
Mailing address
16685 Evergreen Rd
Pine City, MN 55063-5108
Phone (320) 679-1212
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 859711 | Other | MN | AM DIETETIC REGISTRATION |
| 1940 | Other | MN | DIETICIAN LICENSE |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 1940 | MN | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1831240449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16685 EVERGREEN RD",
"city": "PINE CITY",
"state": "MN",
"postal_code": "550635108",
"telephone_number": "320-679-1212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 HIGHWAY 65 S",
"city": "MORA",
"state": "MN",
"postal_code": "550511899",
"telephone_number": "320-225-3640"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MERRICK",
"first_name": "MELISSA",
"middle_name": "L",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "1940",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AM DIETETIC REGISTRATION",
"identifier": "859711",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DIETICIAN LICENSE",
"identifier": "1940",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mora, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.