Provider Demographics
NPI:1477675775
Name:MEYER, KATHLEEN (ANP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 SOUTH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5377
Mailing Address - Country:US
Mailing Address - Phone:973-267-0300
Mailing Address - Fax:973-695-1480
Practice Address - Street 1:182 SOUTH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5377
Practice Address - Country:US
Practice Address - Phone:973-267-0300
Practice Address - Fax:973-695-1480
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO08574200363LA2200X
MA2273436363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP38871Medicare UPIN