Provider Demographics
NPI:1255362828
Name:MEREDITH, GERALD STEVEN (PMH-NP)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:STEVEN
Last Name:MEREDITH
Suffix:
Gender:M
Credentials:PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4514 BROOKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2106
Mailing Address - Country:US
Mailing Address - Phone:423-288-9693
Mailing Address - Fax:
Practice Address - Street 1:JAMES H. QUILLEN/VAMC
Practice Address - Street 2:CORNER OF SIDNEY AND LAMONT
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3529
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000064034363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3346604Medicare ID - Type Unspecified