MEDICARE: MARK ANTHONY MEYER PHD, RN, APRN FNP-BC

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
1	363LF0000X	Family Nurse Practitioner	AP127920	TX

General Provider Information

NPI Number	:	1912394131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ANTHONY MEYER PHD, RN, APRN FNP-BC

Provider Business Mailing Address
First Line	:	2925 N BEND DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-2480
Country	:	US
Telephone Number	:	214-709-8544
Fax Number	:	972-860-4920

Provider Business Practice Location Address
First Line	:	2925 N BEND DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-2480
Country	:	US
Telephone Number	:	214-709-8544
Fax Number	:	972-860-4920

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2015
Last Update Date	:	04/26/2015

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