Healthcare Provider Details

I. General information

NPI: 1194855478
Provider Name (Legal Business Name): HARRIETT DEENE MEFFORD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8211 W STATE ROUTE 66 SUITE A
NEWBURGH IN
47630-2534
US

IV. Provider business mailing address

8211 W STATE ROUTE 66 SUITE A
NEWBURGH IN
47630-2534
US

V. Phone/Fax

Practice location:
  • Phone: 812-490-0463
  • Fax: 812-490-0469
Mailing address:
  • Phone: 812-490-0463
  • Fax: 812-490-0469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000007841
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3004142P
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004795A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: