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General NPI Number Information
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NPI Number | 1164211397
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Entity Type | Individual
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Provider Name | JESSICA ANN MERIDETH MSN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 09/01/2025
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Provider Practice Location Address
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Address Line | 24887 GODDARD RD
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City | TAYLOR
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State | MI
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Zip | 48180-3930
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Country | US
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Telephone | 734-946-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 29071 SUGAR ISLAND CT
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City | GIBRALTAR
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State | MI
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Zip | 48173-9571
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Country | US
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Telephone | 313-720-7862
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F03250739
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License Number State | MI
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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 | 4704327710
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License Number State | MI
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