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General NPI Number Information
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NPI Number | 1063864239
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Entity Type | Individual
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Provider Name | MEGHAN LYNN LIEBUM NP
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Gender | Female
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Dates
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Enumeration Date | 07/12/2016
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 4480 BRYANT IRVIN RD
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City | FORT WORTH
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State | TX
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Zip | 76132-1064
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Country | US
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Telephone | 682-212-9160
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Fax |
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Provider Business Mailing Address
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Address Line | 5937 DONNELLY AVE
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City | FORT WORTH
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State | TX
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Zip | 76107-5811
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Country | US
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Telephone | 281-799-2725
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN2295968
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP134803
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License Number State | TX
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