Provider Demographics
NPI:1528768744
Name:GENTRY, MEGHAN E (FNP)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:E
Last Name:GENTRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:E
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4625 E STIPP RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-9301
Mailing Address - Country:US
Mailing Address - Phone:812-345-2312
Mailing Address - Fax:
Practice Address - Street 1:4625 E STIPP RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-9301
Practice Address - Country:US
Practice Address - Phone:812-345-2312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28195262A363LF0000X
IN71014077A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily