Healthcare Provider Details

I. General information

NPI: 1497163968
Provider Name (Legal Business Name): MEREDITH MASONER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 CUMBERLAND AVE STE 100
MIDDLESBORO KY
40965-1299
US

IV. Provider business mailing address

100 AIRPORT GARDENS RD
HAZARD KY
41701-9529
US

V. Phone/Fax

Practice location:
  • Phone: 606-248-3015
  • Fax: 606-248-3024
Mailing address:
  • Phone: 606-487-7503
  • Fax: 606-439-6987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: