Provider Demographics
NPI:1962054650
Name:MERKLEY, ALEC JADE
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:JADE
Last Name:MERKLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5282 S COMMERCE DR STE D110
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5324
Mailing Address - Country:US
Mailing Address - Phone:385-881-0170
Mailing Address - Fax:385-212-3234
Practice Address - Street 1:5282 S COMMERCE DR STE D110
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5324
Practice Address - Country:US
Practice Address - Phone:385-881-0170
Practice Address - Fax:385-212-3234
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker