Provider Demographics
NPI:1124514617
Name:PARRY, MEGHAN MARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:MARIE
Last Name:PARRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MONICA RD
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-7172
Mailing Address - Country:US
Mailing Address - Phone:505-710-2260
Mailing Address - Fax:
Practice Address - Street 1:711 ENCINO PL NE STE D
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2650
Practice Address - Country:US
Practice Address - Phone:505-224-7400
Practice Address - Fax:505-224-7404
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-08
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM53105363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMRN-74191OtherREGISTERED NURSE LICENSE
NM53105OtherADVANCED PRACTICE LICENSE