Provider Demographics
NPI:1093986903
Name:MEREDITH, ANGELA (APN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 BARBARA JORDAN BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3077
Mailing Address - Country:US
Mailing Address - Phone:512-708-1234
Mailing Address - Fax:512-708-4567
Practice Address - Street 1:1301 BARBARA JORDAN BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3077
Practice Address - Country:US
Practice Address - Phone:512-708-1234
Practice Address - Fax:512-708-4567
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX670788363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206424805Medicaid
TX206424806Medicaid
TX844N81OtherBCBS
TX206424807Medicaid
TXTXB127340Medicare PIN
TX844N81OtherBCBS