Provider Demographics
NPI:1255777900
Name:REVELL, MEREDITH N (PA)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:N
Last Name:REVELL
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:12700 PARK CENTRAL DR STE 1210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-1522
Mailing Address - Country:US
Mailing Address - Phone:214-987-3376
Mailing Address - Fax:469-532-0273
Practice Address - Street 1:431 E STATE HIGHWAY 114 STE 300
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1484
Practice Address - Country:US
Practice Address - Phone:817-251-6500
Practice Address - Fax:817-442-0050
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2024-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA08375363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant