Healthcare Provider Details

I. General information

NPI: 1730522962
Provider Name (Legal Business Name): PAULA ANN MEGHOO CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 TOWSON AVE
FORT SMITH AR
72901
US

IV. Provider business mailing address

1001 TOWSON AVE
FORT SMITH AR
72901-4921
US

V. Phone/Fax

Practice location:
  • Phone: 479-441-5011
  • Fax:
Mailing address:
  • Phone: 479-441-5011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberS002275
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: