Provider Demographics
NPI:1083021240
Name:MEYERS, ADAM (AGACNP, RNFA)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:MEYERS
Suffix:
Gender:M
Credentials:AGACNP, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BRIARWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-1009
Mailing Address - Country:US
Mailing Address - Phone:601-270-8284
Mailing Address - Fax:
Practice Address - Street 1:6 BRIARWOOD LOOP
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-1009
Practice Address - Country:US
Practice Address - Phone:601-270-8284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS876127163WR0006X
MSR876127363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00008822Medicaid
MS00008822Medicaid
MS356451YKFFMedicare PIN