Healthcare Provider Details

I. General information

NPI: 1275965592
Provider Name (Legal Business Name): MEREDITH MASHBURN NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 BLACKFORD ST
CHATTANOOGA TN
37403-1405
US

IV. Provider business mailing address

188 INTEGRA VISTAS DR APT 210
HIXSON TN
37343-5425
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-5255
  • Fax:
Mailing address:
  • Phone: 423-635-9347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number30594
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: