Provider Demographics
NPI:1437789138
Name:MEREDITH, GABRIEL L
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:L
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-4543
Mailing Address - Country:US
Mailing Address - Phone:318-614-2923
Mailing Address - Fax:318-283-8954
Practice Address - Street 1:203 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4543
Practice Address - Country:US
Practice Address - Phone:318-614-2923
Practice Address - Fax:318-283-8954
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide