Provider Demographics
NPI:1245930437
Name:MERRIMAN, SERE CATHERINE (PA)
Entity type:Individual
Prefix:
First Name:SERE
Middle Name:CATHERINE
Last Name:MERRIMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 W REELFOOT AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5569
Mailing Address - Country:US
Mailing Address - Phone:731-599-1102
Mailing Address - Fax:731-599-1107
Practice Address - Street 1:1705 W REELFOOT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5569
Practice Address - Country:US
Practice Address - Phone:731-599-1102
Practice Address - Fax:731-599-1107
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5631363A00000X
TN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program