MEDICARE: MEGHAN SUE UNDERWOOD APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	12069	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	3370186	OTHER	TN	MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4167860	OTHER	TN	BCBS PROV #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	12069	OTHER	TN	APN LICENSE

General Provider Information

NPI Number	:	1396793774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN SUE UNDERWOOD APN

Provider Business Mailing Address
First Line	:	PO BOX 7756
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-0756
Country	:	US
Telephone Number	:	252-985-1371
Fax Number	:

Provider Business Practice Location Address
First Line	:	1846 WILSON PIKE
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-7506
Country	:	US
Telephone Number	:	615-829-2565
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	02/23/2009

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