Provider Demographics
NPI:1710978721
Name:MEEKS, DEBORAH KAY (FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:MEEKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26900 CEDAR RD
Mailing Address - Street 2:CCF-BEACHWOOD - INTERNAL MEDICINE - 22N
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1191
Mailing Address - Country:US
Mailing Address - Phone:216-839-3350
Mailing Address - Fax:216-839-3353
Practice Address - Street 1:26900 CEDAR RD
Practice Address - Street 2:CCF-BEACHWOOD - INTERNAL MEDICINE - 22N
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1191
Practice Address - Country:US
Practice Address - Phone:216-839-3350
Practice Address - Fax:216-839-3353
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN28818363LF0000X
OHNP12932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3601801OtherMEDICARE ID TYPE UNSPECIFIED
OH0059902Medicaid
MT810348783OtherBILLING TAX I.D.
MT4300192Medicaid
MT000083062Medicare ID - Type Unspecified
OH0059902Medicaid
MT4300192Medicaid