Healthcare Provider Details

I. General information

NPI: 1942632096
Provider Name (Legal Business Name): JONATHAN DEREK MEEKS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 11/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1254 YEAMANS HALL RD
HANAHAN SC
29410-2787
US

IV. Provider business mailing address

PO BOX 118008
NORTH CHARLESTON SC
29423-8008
US

V. Phone/Fax

Practice location:
  • Phone: 843-554-8312
  • Fax: 843-554-5141
Mailing address:
  • Phone: 843-554-8312
  • Fax: 843-554-5141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18318
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: