Provider Demographics
NPI:1679227656
Name:GAUDIN, MEREDITH R (FNP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:R
Last Name:GAUDIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722-0395
Mailing Address - Country:US
Mailing Address - Phone:225-683-5292
Mailing Address - Fax:225-683-3411
Practice Address - Street 1:27124 HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:LA
Practice Address - Zip Code:70462
Practice Address - Country:US
Practice Address - Phone:225-395-8022
Practice Address - Fax:225-395-8023
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN150600163W00000X
LA224751363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LARN150600OtherRN LICENSE