Provider Demographics
NPI:1649811407
Name:MEEK, KAMMIE KAY
Entity type:Individual
Prefix:
First Name:KAMMIE
Middle Name:KAY
Last Name:MEEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2209
Mailing Address - Country:US
Mailing Address - Phone:812-676-4730
Mailing Address - Fax:
Practice Address - Street 1:719 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2209
Practice Address - Country:US
Practice Address - Phone:812-676-4730
Practice Address - Fax:812-676-4731
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF09191836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily