Healthcare Provider Details

I. General information

NPI: 1154138931
Provider Name (Legal Business Name): MEGHAN SOOP RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 OLD SALEM DR
COOKEVILLE TN
38506-6441
US

IV. Provider business mailing address

2808 OLD SALEM DR
COOKEVILLE TN
38506-6441
US

V. Phone/Fax

Practice location:
  • Phone: 520-370-2394
  • Fax:
Mailing address:
  • Phone: 520-370-2394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number0000256611
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0000256611
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number0000256611
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number0000256611
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: