=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093798167
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA A MEREDITH NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2005
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3001 W BLUE STARR DR
-----------------------------------------------------
City | CLAREMORE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74017-2544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-342-5432
-----------------------------------------------------
Fax | 918-342-0835
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1108 LAVACA ST SUITE 110-320
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78701-2172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-477-4088
-----------------------------------------------------
Fax | 512-482-0390
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 255985
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 118969
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------