Provider Demographics
NPI:1699263129
Name:MERRITT, KRISTY ANNE (RN BSN CDE)
Entity type:Individual
Prefix:MISS
First Name:KRISTY
Middle Name:ANNE
Last Name:MERRITT
Suffix:
Gender:F
Credentials:RN BSN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7705 POPLAR AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3930
Mailing Address - Country:US
Mailing Address - Phone:901-516-6616
Mailing Address - Fax:901-516-6379
Practice Address - Street 1:7705 POPLAR AVE STE 150
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3930
Practice Address - Country:US
Practice Address - Phone:901-516-6616
Practice Address - Fax:901-516-6379
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN103631163WA2000X, 163WD0400X
TN20720236405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No405300000XOther Service ProvidersPrevention Professional