Provider Demographics
NPI:1245336676
Name:MEACHAM, AMY BARRETT (CRNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BARRETT
Last Name:MEACHAM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:BARRETT
Other - Last Name:SASSANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3504 HIGHWAY 280
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3371
Mailing Address - Country:US
Mailing Address - Phone:256-329-7887
Mailing Address - Fax:256-329-7898
Practice Address - Street 1:3504 HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3371
Practice Address - Country:US
Practice Address - Phone:256-329-7887
Practice Address - Fax:256-329-7898
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-084325363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891007240Medicaid
AL051520066OtherBCBS
63-0685246OtherPRICARE TAX ID#
P92984Medicare UPIN
AL051520066Medicare ID - Type Unspecified