Provider Demographics
NPI:1598911703
Name:KLEIBER, MEREDITH ROSS (PNP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ROSS
Last Name:KLEIBER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:LYNN
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:1655 WAKE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4745
Mailing Address - Country:US
Mailing Address - Phone:919-556-4779
Mailing Address - Fax:919-556-5277
Practice Address - Street 1:1655 WAKE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4745
Practice Address - Country:US
Practice Address - Phone:919-556-4779
Practice Address - Fax:919-556-5277
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC194551363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC20080225OtherPNCP CERTIFICATION
NC890115LMedicaid
NC7004613Medicaid