Provider Demographics
NPI:1043676851
Name:BREYER, MEGAN DOROTHY (NP)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:DOROTHY
Last Name:BREYER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2422
Mailing Address - Country:US
Mailing Address - Phone:931-526-6100
Mailing Address - Fax:931-526-6002
Practice Address - Street 1:435 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2422
Practice Address - Country:US
Practice Address - Phone:931-526-6100
Practice Address - Fax:931-526-6002
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20697363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics