JENISHA RAE MERMIS (NPI# 1407409428) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407409428 |
| Entity Type | Individual |
| Full Name | JENISHA RAE MERMIS |
| Practice Address |
1090 Arnold Dr Little Rock Afb AR 72099-4933 |
| Mailing Address |
327 W Sunset Rd Apt 2228 San Antonio TX 78209-1750 |
| Practice Telephone | 5203089190 |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2019-07-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1003X |
Military Health Care Provider Specialization: Independent Duty Medical Technicians |
Other Service Providers |
| Street Address |
1090 ARNOLD DR |
| City | LITTLE ROCK AFB |
| State | AR |
| Zip Code | 72099-4933 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558353524 | Ruth Paula Gullotta | Pediatrics | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2005-08-16 |
| 1669087961 | Franko Salazar | Physician Assistant | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2020-09-14 |
| 1023642840 | Cara D Roth | Social Worker | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2020-03-02 |
| 1154971513 | Timothy Ryan Southerland | Psychologist | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2019-09-18 |
| 1457810848 | Dennis Dale Jackson II | Pharmacist | 1090 Arnold Dr, Little Rock Afb, AR 72099 | 2019-03-15 |
| 1053877902 | Chase Andrew Cannon | Physician Assistant | 1090 Arnold Dr, Little Rock Afb, AR 72099-2502 | 2019-02-15 |
| 1235600461 | Leeanne Elizabeth Ogle | Military Health Care Provider | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2018-12-16 |
| 1972078004 | Meghan Rachelle Dailey | Physician Assistant | 1090 Arnold Dr, Little Rock Afb, AR 72099-1043 | 2018-10-04 |
| 1760977979 | Lashica Davis | Pharmacist | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2018-06-29 |
| 1871019992 | Brendan T Bilski | Dentist | 1090 Arnold Dr, Little Rock Afb, AR 72099-5529 | 2017-08-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356876577 | Little Rock Air Force Base Eye Care | Optometrist | 6th Street, Bldg 787, Little Rock Air Force Base, Little Rock, AR 72099 | 2017-04-25 |
| 1841636206 | National Vision Optical | Technician/Technologist | Bldg 787 6th St., Little Rock, AR 72099 | 2013-05-13 |
| 1134341076 | Keisha Denythia Henry | Psychologist | 314 Medical Group, Life Skills Support Center, 1090 Arnold Drive, Little Rock Afb, AR 72099 | 2007-05-02 |
| 1699213454 | Teryn Ardell Freeman | Physician Assistant | 19th Medical Group, 1090 Arnold Drive, Little Rock, AR 72099 | 2017-02-01 |
| 1730314899 | Andrew Chichick Iv | Military Health Care Provider | 1090 Arnold Drive, 19 Amds/sgpf, Little Rock Afb, AR 72099 | 2009-05-19 |
| 1427316488 | Sunland Optical Co., Inc. | Eyewear Supplier (Equipment, not the service) | 6 Th St Bldg 787, Little Rock Afb, AR 72099-0001 | 2012-04-27 |
| 1700174828 | Lewis Mark Wiggins | Family Medicine | 19th Medical Group, Jacksonville, AR 72099-0001 | 2011-07-11 |
| 1104052158 | Seth Thomas Tolliver | Nurse Practitioner | 101 Master Sergeant Dan Wassom, Little Rock Afb, AR 72099-0001 | 2009-06-04 |
| 1316171994 | Jeff J. Sandoval | Military Health Care Provider | 19 Amds Sgopf, 1090 Arnold Dr, Little Rock Afb, AR 72099-0001 | 2009-05-11 |
| 1366610198 | Robert Anthony Olivi Jr. | Physician Assistant | 19th Medical Group 1090 Arnold Drive, Little Rock Air Force Base, AR 72099-0001 | 2008-02-14 |
| Find all providers in zip 72099 | ||||
| Taxonomy Code | 1710I1003X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Medical Technicians |
| An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision. An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT. An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility. IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians. |
| Notes: Source: Air Force Surgeon General Office [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316171994 | Jeff J. Sandoval | Military Health Care Provider | 19 Amds Sgopf, 1090 Arnold Dr, Little Rock Afb, AR 72099-0001 | 2009-05-11 |
| 1235600461 | Leeanne Elizabeth Ogle | Military Health Care Provider | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2018-12-16 |
| 1427351030 | Tiffani Mckee | Military Health Care Provider | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2010-12-21 |
| 1730314899 | Andrew Chichick Iv | Military Health Care Provider | 1090 Arnold Drive, 19 Amds/sgpf, Little Rock Afb, AR 72099 | 2009-05-19 |
| 1487888574 | Tommy Nelson Belcher | Military Health Care Provider | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2009-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174045868 | Jonathan Rashad Habersham | Military Health Care Provider | 1255 Vandenberg Dr, Jacksonville, AR 72099-4942 | 2017-07-13 |
| 1679025795 | Claudia Irene Sloan | Military Health Care Provider | 1090 Arnold Dr, Jacksonville, AR 72099-4933 | 2016-10-25 |
| 1770718017 | Christopher John Hoar | Military Health Care Provider | 1090 Arnold Dr, Bldg 1090/flight Medicine, Lr Afb, AR 72099-4933 | 2009-05-15 |
| City | LITTLE ROCK AFB |
| Zip Code | 72099 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.