Provider Demographics
NPI:1316466642
Name:MERTZ, LARYN ELISE (ARNP, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LARYN
Middle Name:ELISE
Last Name:MERTZ
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2091
Mailing Address - Country:US
Mailing Address - Phone:859-236-1080
Mailing Address - Fax:859-236-1862
Practice Address - Street 1:303 S 4TH ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2091
Practice Address - Country:US
Practice Address - Phone:859-236-1080
Practice Address - Fax:859-236-1862
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100522780Medicaid