Provider Demographics
NPI:1164021010
Name:MEREDITH, TRINIKA MICHELLE
Entity Type:Individual
Prefix:MS
First Name:TRINIKA
Middle Name:MICHELLE
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 AMBROSE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-6772
Mailing Address - Country:US
Mailing Address - Phone:901-574-2255
Mailing Address - Fax:
Practice Address - Street 1:4225 AMBROSE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6772
Practice Address - Country:US
Practice Address - Phone:901-574-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN200009318343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)