Provider Demographics
NPI:1417558446
Name:PERALTA, MEGHAN ASHLEY (CRNP)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ASHLEY
Last Name:PERALTA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:ASHLEY
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2000 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-2110
Mailing Address - Country:US
Mailing Address - Phone:205-801-8415
Mailing Address - Fax:205-502-9914
Practice Address - Street 1:500 22ND ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-3110
Practice Address - Country:US
Practice Address - Phone:205-504-6098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-173079363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology