Provider Demographics
NPI:1396793774
Name:UNDERWOOD, MEGHAN SUE (APN)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:SUE
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:APN
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 7756
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0756
Mailing Address - Country:US
Mailing Address - Phone:252-985-1371
Mailing Address - Fax:
Practice Address - Street 1:1846 WILSON PIKE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-7506
Practice Address - Country:US
Practice Address - Phone:615-829-2565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12069363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370186OtherMEDICAID GROUP #
TN4167860OtherBCBS PROV #
TN36432461Medicaid
TN12069OtherAPN LICENSE
TN3370186OtherMEDICARE GROUP #
TN3370186OtherMEDICARE GROUP #