Healthcare Provider Details

I. General information

NPI: 1124296561
Provider Name (Legal Business Name): MEREDITH RICHARDSON SHRADER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 WILLOW RIDGE DR
CHUCKEY TN
37641-5311
US

IV. Provider business mailing address

135 WILLOW RIDGE DR
CHUCKEY TN
37641-5311
US

V. Phone/Fax

Practice location:
  • Phone: 919-946-5988
  • Fax:
Mailing address:
  • Phone: 919-946-5988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2324
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: