Healthcare Provider Details

I. General information

NPI: 1265786008
Provider Name (Legal Business Name): MEGHAN RAE TEEL NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 JEFFERSON AVE
MEMPHIS TN
38103
US

IV. Provider business mailing address

11314 E REMBRANDT AVE
MESA AZ
85212-4093
US

V. Phone/Fax

Practice location:
  • Phone: 901-545-7366
  • Fax:
Mailing address:
  • Phone: 901-590-5402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP5714
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number15537
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: