Provider Demographics
NPI:1811634835
Name:GAITLEY, MEREDITH PAIGE (FNP-C)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:PAIGE
Last Name:GAITLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 S BELLS ST
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TN
Mailing Address - Zip Code:38001-1700
Mailing Address - Country:US
Mailing Address - Phone:731-696-5401
Mailing Address - Fax:
Practice Address - Street 1:335 N FAIRGROUNDS ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-4726
Practice Address - Country:US
Practice Address - Phone:731-426-2370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN182924163WG0000X
TNF06221472363LF0000X
TN32486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice