Provider Demographics
NPI:1346977428
Name:MEADOWS, JERRY WAYNE
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:WAYNE
Last Name:MEADOWS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 SIERRA LN
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1668
Mailing Address - Country:US
Mailing Address - Phone:304-415-6510
Mailing Address - Fax:
Practice Address - Street 1:5412 SIERRA LN
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-1668
Practice Address - Country:US
Practice Address - Phone:304-415-6510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant