Healthcare Provider Details

I. General information

NPI: 1780037630
Provider Name (Legal Business Name): MEREDITH POLITTE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W LIBERTY ST
FARMINGTON MO
63640-1921
US

IV. Provider business mailing address

1431 CENTERPOINT BLVD STE 100
KNOXVILLE TN
37932-1983
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-6451
  • Fax:
Mailing address:
  • Phone: 865-985-7133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2015043782
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015043782
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: