Provider Demographics
NPI:1255978631
Name:MERRIMAN, CRYSTAL (PMHNP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MERRIMAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:MANGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1832
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-1832
Mailing Address - Country:US
Mailing Address - Phone:620-231-1960
Mailing Address - Fax:620-231-2808
Practice Address - Street 1:106 NW VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-1818
Practice Address - Country:US
Practice Address - Phone:888-777-9170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS79127363LF0000X
OK137463363LF0000X
OKM0137463363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily