Provider Demographics
NPI:1619366119
Name:MEREDITH, NICHOLA JANE (PA-C)
Entity Type:Individual
Prefix:
First Name:NICHOLA
Middle Name:JANE
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 ALLENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3200
Mailing Address - Country:US
Mailing Address - Phone:281-422-4141
Mailing Address - Fax:281-422-5939
Practice Address - Street 1:4308 ALLENBROOK DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3200
Practice Address - Country:US
Practice Address - Phone:281-422-4141
Practice Address - Fax:281-422-5939
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant