Provider Demographics
NPI:1700594173
Name:MEEKS, MARY ALICE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ALICE
Last Name:MEEKS
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 1:1295 FRANCES CRK
Mailing Address - Street 2:
Mailing Address - City:HARTS
Mailing Address - State:WV
Mailing Address - Zip Code:25524-8085
Mailing Address - Country:US
Mailing Address - Phone:304-855-7162
Mailing Address - Fax:
Practice Address - Street 1:1295 FRANCES CRK
Practice Address - Street 2:
Practice Address - City:HARTS
Practice Address - State:WV
Practice Address - Zip Code:25524-8085
Practice Address - Country:US
Practice Address - Phone:304-855-7162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3048557162Other3048557162