Provider Demographics
NPI:1508519992
Name:MEYER, NATHAN RYAN
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:RYAN
Last Name:MEYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 E RICHARD SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-8033
Mailing Address - Country:US
Mailing Address - Phone:559-368-3060
Mailing Address - Fax:
Practice Address - Street 1:1344 S. ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631
Practice Address - Country:US
Practice Address - Phone:559-556-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician