Provider Demographics
NPI:1760153779
Name:MEACHAM, JONATHAN RICHARD (FNP)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:RICHARD
Last Name:MEACHAM
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6908 MESA RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-1533
Mailing Address - Country:US
Mailing Address - Phone:719-471-2273
Mailing Address - Fax:719-325-8971
Practice Address - Street 1:6908 MESA RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1533
Practice Address - Country:US
Practice Address - Phone:719-471-2273
Practice Address - Fax:719-325-8971
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO0996942363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner