Provider Demographics
NPI:1386466944
Name:MEREDITH M HAKE, RN, FMPHNP, PA
Entity type:Organization
Organization Name:MEREDITH M HAKE, RN, FMPHNP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, FMPHNP, PA
Authorized Official - Phone:972-895-3189
Mailing Address - Street 1:1332 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7689
Mailing Address - Country:US
Mailing Address - Phone:469-471-4405
Mailing Address - Fax:
Practice Address - Street 1:4325 WINDSOR CENTRE TRL STE 200
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1866
Practice Address - Country:US
Practice Address - Phone:972-895-3189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)