Provider Demographics
NPI:1992451066
Name:STATAM, MESHA JEANAE (LVN)
Entity type:Individual
Prefix:
First Name:MESHA
Middle Name:JEANAE
Last Name:STATAM
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 CHARLESTON CT APT A
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-4728
Mailing Address - Country:US
Mailing Address - Phone:254-768-9040
Mailing Address - Fax:
Practice Address - Street 1:2003 CHARLESTON CT APT A
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-4728
Practice Address - Country:US
Practice Address - Phone:254-768-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-26
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1066720164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse