Provider Demographics
NPI:1023124104
Name:STORK, MEGHAN RAE (CNM)
Entity type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:RAE
Last Name:STORK
Suffix:
Gender:F
Credentials:CNM
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 66308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266
Mailing Address - Country:US
Mailing Address - Phone:832-548-5076
Mailing Address - Fax:713-523-4897
Practice Address - Street 1:6441 HIGH STAR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074
Practice Address - Country:US
Practice Address - Phone:832-548-5000
Practice Address - Fax:713-523-4897
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK070704176B00000X
TX659312176B00000X, 367A00000X
OKR0070704367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080462703Medicaid
TX080462703Medicaid