Provider Demographics
NPI:1225712128
Name:MISSILDINE, MEREDITH BRIANNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:BRIANNE
Last Name:MISSILDINE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14530 MONTGOMERY HWY
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HOME
Mailing Address - State:AL
Mailing Address - Zip Code:36041-3736
Mailing Address - Country:US
Mailing Address - Phone:334-467-6981
Mailing Address - Fax:
Practice Address - Street 1:185 MITYLENE PARK LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7302
Practice Address - Country:US
Practice Address - Phone:334-387-0948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-171698363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner