Healthcare Provider Details

I. General information

NPI: 1740653153
Provider Name (Legal Business Name): VALERIE MEYERS NP ADULT HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

662 S MAIN ST UNIT 5
CENTRAL SQUARE NY
13036-3524
US

IV. Provider business mailing address

PO BOX 91
WATERTOWN NY
13601-0091
US

V. Phone/Fax

Practice location:
  • Phone: 315-668-5010
  • Fax: 315-668-1940
Mailing address:
  • Phone: 315-782-4207
  • Fax: 315-782-8699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number301393
License Number StateNY

VIII. Authorized Official

Name: MRS. VALERIE MEYERS
Title or Position: NURSE PRACTITIONER IN ADULT HEALTH
Credential: ANP
Phone: 315-668-5010