Provider Demographics
NPI:1710444773
Name:MEADE, BETH A (APRN)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:MEADE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ELK FORK RD
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:KY
Mailing Address - Zip Code:42220-7218
Mailing Address - Country:US
Mailing Address - Phone:270-265-2574
Mailing Address - Fax:
Practice Address - Street 1:105 ELK FORK RD
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:KY
Practice Address - Zip Code:42220-7218
Practice Address - Country:US
Practice Address - Phone:270-265-2574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine