Healthcare Provider Details

I. General information

NPI: 1467760447
Provider Name (Legal Business Name): JODY BENNETT-MEEHAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E WATER ST
MUNCY PA
17756-8828
US

IV. Provider business mailing address

215 E WATER ST
MUNCY PA
17756-8828
US

V. Phone/Fax

Practice location:
  • Phone: 570-546-8282
  • Fax:
Mailing address:
  • Phone: 570-546-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA054532
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: