Individual
JESSICA K MEREDITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
36491 YAMAS DR, WILDOMAR, CA 92595-9809
(716) 912-8469
Mailing address
36491 YAMAS DR, APT 3108, WILDOMAR, CA 92595-9809
(716) 912-8469
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5132
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
699579
—
AZ
Enumeration date
04/03/2012
Last updated
11/18/2013
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