Individual
DERRICK MEADOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN, PMHNP-BC, CNL
Contact information
Practice address
8130 COUNTRY VILLAGE DR STE 103, CORDOVA, TN 38016-2087
(901) 308-2915
(901) 308-2924
Mailing address
8130 COUNTRY VILLAGE DR STE 102, CORDOVA, TN 38016-2087
(901) 308-2915
(901) 308-2924
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
903854
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2C6508
—
MS
05
—
T871106H
—
TN
Enumeration date
02/20/2020
Last updated
08/01/2023
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