Provider Demographics
NPI:1235639709
Name:TIMBERLAKE, MEAGHAN NICOL (APRN, MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:NICOL
Last Name:TIMBERLAKE
Suffix:
Gender:F
Credentials:APRN, MSN, FNP-C
Other - Prefix:
Other - First Name:MEAGHAN
Other - Middle Name:NICHOL
Other - Last Name:KOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, MSN, FNP-C
Mailing Address - Street 1:1620 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1008
Mailing Address - Country:US
Mailing Address - Phone:801-822-2234
Mailing Address - Fax:
Practice Address - Street 1:602 31ST ST
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861-3512
Practice Address - Country:US
Practice Address - Phone:210-202-0250
Practice Address - Fax:830-331-2287
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136326363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty