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General NPI Number Information
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NPI Number | 1255203857
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Entity Type | Individual
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Provider Name | SHATHENA BRYANNE MEEDER NP
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Gender | Female
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Dates
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Enumeration Date | 09/22/2025
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 125 S WASHINGTON ST
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City | AFTON
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State | WY
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Zip | 83110-5117
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Country | US
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Telephone | 307-886-5266
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Fax |
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Provider Business Mailing Address
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Address Line | 6715 GHARRETT AVE
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City | MISSOULA
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State | MT
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Zip | 59803-3203
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Country | US
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Telephone | 406-381-1076
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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 | 57803
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License Number State | WY
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