Provider Demographics
NPI:1285308247
Name:PLUNKETT, JOHN MEREDITH
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MEREDITH
Last Name:PLUNKETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-2059
Mailing Address - Country:US
Mailing Address - Phone:804-240-1138
Mailing Address - Fax:
Practice Address - Street 1:108 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-2059
Practice Address - Country:US
Practice Address - Phone:804-240-1138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist