Provider Demographics
NPI:1710578877
Name:GUNNESS, MEGHAN PETHO (FNP-C)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:PETHO
Last Name:GUNNESS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41164 LEE CT
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-8926
Mailing Address - Country:US
Mailing Address - Phone:225-572-4242
Mailing Address - Fax:
Practice Address - Street 1:5800 ONE PERKINS
Practice Address - Street 2:BUILDING 5 SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808
Practice Address - Country:US
Practice Address - Phone:225-328-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA218045363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner