Provider Demographics
NPI:1912394131
Name:MEYER, MARK ANTHONY (PHD, RN, APRN FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:MEYER
Suffix:
Gender:M
Credentials:PHD, RN, APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 N BEND DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-2480
Mailing Address - Country:US
Mailing Address - Phone:214-709-8544
Mailing Address - Fax:972-860-4920
Practice Address - Street 1:2925 N BEND DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-2480
Practice Address - Country:US
Practice Address - Phone:214-709-8544
Practice Address - Fax:972-860-4920
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-26
Last Update Date:2015-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily