Healthcare Provider Details

I. General information

NPI: 1548956352
Provider Name (Legal Business Name): AMY MEKAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 S WALNUT ST
DEXTER MO
63841-2146
US

IV. Provider business mailing address

1500 N WESTWOOD BLVD
POPLAR BLUFF MO
63901-3318
US

V. Phone/Fax

Practice location:
  • Phone: 573-820-2097
  • Fax:
Mailing address:
  • Phone: 573-820-2097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number2002015431
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: