Provider Demographics
NPI:1164037750
Name:MEEHAN, TRUDY ANN (NP-C)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:ANN
Last Name:MEEHAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-8803
Mailing Address - Country:US
Mailing Address - Phone:307-258-2971
Mailing Address - Fax:
Practice Address - Street 1:332 PERRY ST
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-8803
Practice Address - Country:US
Practice Address - Phone:307-258-2971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1017831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily