Provider Demographics
NPI:1205040227
Name:AMY MERYDITH DUNN
Entity Type:Organization
Organization Name:AMY MERYDITH DUNN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MERYDITH DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, FNP-C
Authorized Official - Phone:806-658-4531
Mailing Address - Street 1:146 PIONEER DR
Mailing Address - Street 2:
Mailing Address - City:BOOKER
Mailing Address - State:TX
Mailing Address - Zip Code:79005-6008
Mailing Address - Country:US
Mailing Address - Phone:806-658-4531
Mailing Address - Fax:806-658-9344
Practice Address - Street 1:146 PIONEER DR
Practice Address - Street 2:
Practice Address - City:BOOKER
Practice Address - State:TX
Practice Address - Zip Code:79005-6008
Practice Address - Country:US
Practice Address - Phone:806-658-4531
Practice Address - Fax:806-658-9344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX652675261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ78312Medicare UPIN