Healthcare Provider Details

I. General information

NPI: 1508546615
Provider Name (Legal Business Name): MEREDITH GUENTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 11/20/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 TUSKEGEE AIRMEN AVE.
SHEPPARD AIR FORCE BASE TX
76311-3478
US

IV. Provider business mailing address

527 TUSKEGEE AIRMEN AVE.
SHEPPARD AIR FORCE BASE TX
76311-3478
US

V. Phone/Fax

Practice location:
  • Phone: 940-676-1035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: