Healthcare Provider Details

I. General information

NPI: 1922515493
Provider Name (Legal Business Name): MEAGHAN SCHENK JOHNSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEAGHAN CATHERINE SCHENK FNP-C

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2969 CURRAN DR N # 200
JACKSON MS
39216-4121
US

IV. Provider business mailing address

128 WELLS CT
CANTON MS
39046-7004
US

V. Phone/Fax

Practice location:
  • Phone: 601-974-5600
  • Fax:
Mailing address:
  • Phone: 601-951-0433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number902290
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902290
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: