Healthcare Provider Details

I. General information

NPI: 1316080146
Provider Name (Legal Business Name): MEREDITH A MYERS PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH A NORRIS PNP

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SHAPE DR
KENNEBUNK ME
04043-6601
US

IV. Provider business mailing address

1 MEDICAL CENTER DR PO BOX 626
BIDDEFORD ME
04005-9422
US

V. Phone/Fax

Practice location:
  • Phone: 207-467-8930
  • Fax: 207-985-8459
Mailing address:
  • Phone: 207-282-9080
  • Fax: 207-985-8459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCNP81663
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP81663
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR041189
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier30346785
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer
# 2
Identifier432994999
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: