Provider Demographics
NPI:1962965491
Name:SMITH, MEAGEN LEANN (NP)
Entity type:Individual
Prefix:
First Name:MEAGEN
Middle Name:LEANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2322
Mailing Address - Country:US
Mailing Address - Phone:903-577-1101
Mailing Address - Fax:903-577-0771
Practice Address - Street 1:301 W 19TH ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2322
Practice Address - Country:US
Practice Address - Phone:903-577-1101
Practice Address - Fax:903-577-0771
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141151363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner