Provider Demographics
NPI:1811260540
Name:PETERSON, MEGHAN SANDIDGE (CFNP)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:SANDIDGE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:ELIZABETH
Other - Last Name:SANDIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:307 HOSPITAL ROAD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759
Mailing Address - Country:US
Mailing Address - Phone:662-615-3821
Mailing Address - Fax:662-615-3830
Practice Address - Street 1:307 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759
Practice Address - Country:US
Practice Address - Phone:662-615-3821
Practice Address - Fax:662-615-3830
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR879604363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily