Provider Demographics
NPI:1033675798
Name:MERRITT, ANDRIA MORAN (APRN)
Entity type:Individual
Prefix:
First Name:ANDRIA
Middle Name:MORAN
Last Name:MERRITT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANDRIA
Other - Middle Name:
Other - Last Name:GLOVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:520 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-3528
Mailing Address - Country:US
Mailing Address - Phone:870-741-8286
Mailing Address - Fax:870-741-7481
Practice Address - Street 1:520 N SPRING ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3528
Practice Address - Country:US
Practice Address - Phone:870-741-8286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA006134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily