Provider Demographics
NPI:1679298590
Name:SPEIGHT, MEREDITH RIDDLE (FNP)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:RIDDLE
Last Name:SPEIGHT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:KAITLIN
Other - Last Name:RIDDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2485 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5949
Practice Address - Country:US
Practice Address - Phone:702-212-5889
Practice Address - Fax:702-212-5890
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV868512363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV82477OtherMEDICARE PTAN