Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | R876127 | MS |
NPI | 1083021240 |
---|---|
Provider Name | Adam Meyers |
First Address | Hattiesburg, MS 39401-7246 |
Second Address | Hattiesburg, MS 39401-7246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2014 |
Last Update Date | 24/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00008822 | (05) | MS |