Provider Demographics
NPI:1710640859
Name:NURSE PRACTITIONER ASSOCIATES OF MERIDIAN
Entity Type:Organization
Organization Name:NURSE PRACTITIONER ASSOCIATES OF MERIDIAN
Other - Org Name:NURSE PRACTITIONER ASSOCIATES OF MERIDIAN LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, GNP-BC
Authorized Official - Phone:601-527-7585
Mailing Address - Street 1:PO BOX 3272
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39303-3272
Mailing Address - Country:US
Mailing Address - Phone:601-527-7585
Mailing Address - Fax:
Practice Address - Street 1:3701 8TH ST STE B
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-6083
Practice Address - Country:US
Practice Address - Phone:601-527-7585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty