Provider Demographics
NPI:1619596772
Name:MERRITT, MARK AUSTIN (CRNP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:AUSTIN
Last Name:MERRITT
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 VESTAVIA PKWY STE 406
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-3763
Mailing Address - Country:US
Mailing Address - Phone:256-980-0620
Mailing Address - Fax:919-918-0622
Practice Address - Street 1:523 KEISLER DR STE 202
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7099
Practice Address - Country:US
Practice Address - Phone:919-918-0620
Practice Address - Fax:919-918-0622
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-173916163W00000X
NC5015132363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse