Provider Demographics
NPI:1619615051
Name:MEADOR, GATLIN DELL (PA)
Entity Type:Individual
Prefix:
First Name:GATLIN
Middle Name:DELL
Last Name:MEADOR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15365 TOP DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-3760
Mailing Address - Country:US
Mailing Address - Phone:319-486-8173
Mailing Address - Fax:
Practice Address - Street 1:2728 2ND AVE S
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-6710
Practice Address - Country:US
Practice Address - Phone:515-574-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant