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NPI Code Detail

MEDICARE: RACHEL RUSSELL MEADORS CRNP

MEDICARE: RACHEL RUSSELL MEADORS CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerRN286724GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RN286724OTHERGAMEDICAL LICENSE

General Provider Information

NPI Number : 1811333784
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHEL RUSSELL MEADORS CRNP
Provider Business Mailing Address
First Line : 1100 7TH AVE
Second Line :
City : JASPER
State : AL
Zip : 35501
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 S MADISON ST
Second Line :
City : THOMASVILLE
State : GA
Zip : 31792-5473
Country : US
Telephone Number : 229-221-9552
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2013
Last Update Date : 04/29/2020

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