Provider Demographics
NPI:1134713027
Name:WHATLEY, MEGHANN R (FNP)
Entity type:Individual
Prefix:
First Name:MEGHANN
Middle Name:R
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 735
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AR
Mailing Address - Zip Code:72722-0735
Mailing Address - Country:US
Mailing Address - Phone:479-752-3233
Mailing Address - Fax:479-752-3235
Practice Address - Street 1:346 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AR
Practice Address - Zip Code:72722-9732
Practice Address - Country:US
Practice Address - Phone:479-752-3233
Practice Address - Fax:479-752-3235
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR214871363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR214871OtherARKANSAS STATE NURSING BOARD