Healthcare Provider Details

I. General information

NPI: 1679298590
Provider Name (Legal Business Name): MEREDITH RIDDLE SPEIGHT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH KAITLIN RIDDLE

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89052-5949
US

IV. Provider business mailing address

PO BOX 603725
CHARLOTTE NC
28260-3725
US

V. Phone/Fax

Practice location:
  • Phone: 702-212-5889
  • Fax: 702-212-5890
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number868512
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: