Provider Demographics
NPI:1467544049
Name:MEYER, MARY K (APN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:K
Last Name:MEYER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 839
Mailing Address - Street 2:1309 WEST MAIN STREET
Mailing Address - City:WALNUT RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72476-0839
Mailing Address - Country:US
Mailing Address - Phone:870-886-3211
Mailing Address - Fax:870-886-9027
Practice Address - Street 1:1309 WEST MAIN STREET
Practice Address - Street 2:FAMILY MEDICAL CENTER
Practice Address - City:WALNUT RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72476-0839
Practice Address - Country:US
Practice Address - Phone:870-886-3211
Practice Address - Fax:870-886-9027
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARAO1182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5S965Medicare ID - Type Unspecified