Provider Demographics
NPI:1700805314
Name:MERRITT, JOHN A (CRNA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:MERRITT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 800129
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75380-0129
Mailing Address - Country:US
Mailing Address - Phone:888-324-7432
Mailing Address - Fax:972-528-5309
Practice Address - Street 1:3810 HUGHES CT
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-6205
Practice Address - Country:US
Practice Address - Phone:936-639-3036
Practice Address - Fax:936-639-3064
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX048168367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX003398702Medicaid
TX82690UOtherBCBS