Healthcare Provider Details

I. General information

NPI: 1598366296
Provider Name (Legal Business Name): ABIGAIL ELLERY MEREDITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2020
Last Update Date: 11/08/2020
Certification Date: 11/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 E OLIVE AVE
FRESNO CA
93702-1030
US

IV. Provider business mailing address

1942 EVERGLADE AVE
CLOVIS CA
93619-2854
US

V. Phone/Fax

Practice location:
  • Phone: 559-412-4927
  • Fax:
Mailing address:
  • Phone: 559-451-1323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: