Provider Demographics
NPI:1407516917
Name:EVERETT, MEGGAN (CNM)
Entity Type:Individual
Prefix:MS
First Name:MEGGAN
Middle Name:
Last Name:EVERETT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 POPLAR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-8105
Mailing Address - Country:US
Mailing Address - Phone:601-938-7351
Mailing Address - Fax:
Practice Address - Street 1:405 BRIARWOOD DR STE 303
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-3052
Practice Address - Country:US
Practice Address - Phone:769-233-8163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSCNM07091367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife