=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013923796
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA JANE MEEDS PSY. D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 S. MAIN ST. SUITE 207
-----------------------------------------------------
City | MOORESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28115-2372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-662-0124
-----------------------------------------------------
Fax | 704-662-9192
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 S. MAIN ST. SUITE 207
-----------------------------------------------------
City | MOORESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28115-2372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-662-0124
-----------------------------------------------------
Fax | 704-662-9192
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 2226
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------