Provider Demographics
NPI:1871751784
Name:DAVIS, MEREDITH HARDEE (ANP)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:HARDEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:LEANN
Other - Last Name:HARDEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4692 BROWNSBORO RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3410
Mailing Address - Country:US
Mailing Address - Phone:336-251-1114
Mailing Address - Fax:336-251-1115
Practice Address - Street 1:4692 BROWNSBORO RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3410
Practice Address - Country:US
Practice Address - Phone:336-251-1114
Practice Address - Fax:336-251-1115
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC191135363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00635040OtherRAILROAD MEDICARE
2593299Medicare PIN