Provider Demographics
NPI:1912366071
Name:MERRIMAN, AMY LYNN (PA-C)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNN
Last Name:MERRIMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:MONK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10142 PARKSIDE DR STE 500
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-1954
Mailing Address - Country:US
Mailing Address - Phone:865-393-0040
Mailing Address - Fax:800-783-1273
Practice Address - Street 1:10142 PARKSIDE DR STE 500
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-1954
Practice Address - Country:US
Practice Address - Phone:865-393-0040
Practice Address - Fax:800-783-1273
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113066363A00000X
TN2951363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant