Healthcare Provider Details

I. General information

NPI: 1750171906
Provider Name (Legal Business Name): BENJAMIN MEYER NP, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 RIVER DR STE A
FORT BRAGG CA
95437-5403
US

IV. Provider business mailing address

548 WEST ST
FORT BRAGG CA
95437-3232
US

V. Phone/Fax

Practice location:
  • Phone: 707-961-4631
  • Fax:
Mailing address:
  • Phone: 707-508-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95035821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: