Provider Demographics
NPI:1700371846
Name:MEACHAM, SELENA JANE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SELENA
Middle Name:JANE
Last Name:MEACHAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:SELENA
Other - Middle Name:JANE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:608 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:IA
Mailing Address - Zip Code:50574-1000
Mailing Address - Country:US
Mailing Address - Phone:712-335-5632
Mailing Address - Fax:
Practice Address - Street 1:608 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:IA
Practice Address - Zip Code:50574-1000
Practice Address - Country:US
Practice Address - Phone:712-335-5632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA133870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily