Provider Demographics
NPI:1942632096
Name:MEEKS, JONATHAN DEREK (FNP)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DEREK
Last Name:MEEKS
Suffix:
Gender:M
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:PO BOX 118008
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29423-8008
Mailing Address - Country:US
Mailing Address - Phone:843-554-8312
Mailing Address - Fax:843-554-5141
Practice Address - Street 1:1254 YEAMANS HALL RD
Practice Address - Street 2:
Practice Address - City:HANAHAN
Practice Address - State:SC
Practice Address - Zip Code:29410-2787
Practice Address - Country:US
Practice Address - Phone:843-554-8312
Practice Address - Fax:843-554-5141
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18318363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2458Medicaid
SCSC16727819Medicare PIN
SCSC16728798Medicare PIN
SCSC16725277Medicare PIN
SCSC16725281Medicare PIN
SCNP2458Medicaid
SCSC16726834Medicare PIN
SCSC16727006Medicare PIN
SCSC16727126Medicare PIN
SCSC16727498Medicare PIN
SCSC16727522Medicare PIN
SCSC16726882Medicare PIN
SCSC16725282Medicare PIN
SCSC16727499Medicare PIN
SCSC16727555Medicare PIN