Provider Demographics
NPI:1184652075
Name:MEYERS, JOAN (PAC)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:MEYERS
Suffix:
Gender:
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 GAIL GARDNER WAY
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-2337
Mailing Address - Country:US
Mailing Address - Phone:928-445-5211
Mailing Address - Fax:928-445-5189
Practice Address - Street 1:726 GAIL GARDNER WAY
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-2337
Practice Address - Country:US
Practice Address - Phone:928-445-5211
Practice Address - Fax:928-445-5189
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1204363LF0000X
AZAZ1390363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ110255Medicaid
AZ110255Medicaid
AZS46509Medicare UPIN