Healthcare Provider Details

I. General information

NPI: 1497542807
Provider Name (Legal Business Name): ANGELA DENISE MEADORS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 E VAN BUREN ST
PHOENIX AZ
85008-6088
US

IV. Provider business mailing address

14518 SAINT CHARLES DR
OLIVE BRANCH MS
38654-2067
US

V. Phone/Fax

Practice location:
  • Phone: 602-273-9999
  • Fax:
Mailing address:
  • Phone: 901-677-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number37614
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number331463
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: