Provider Demographics
NPI:1770082463
Name:OLIVER, MEREDITH WALKER (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MISS
First Name:MEREDITH
Middle Name:WALKER
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:WELLS
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:815 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-8907
Mailing Address - Country:US
Mailing Address - Phone:864-466-2498
Mailing Address - Fax:
Practice Address - Street 1:1663 CAMPUS PARK DR STE D
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5582
Practice Address - Country:US
Practice Address - Phone:704-291-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07840363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty