Provider Demographics
NPI:1255203857
Name:MEEDER, SHATHENA BRYANNE (NP)
Entity type:Individual
Prefix:
First Name:SHATHENA
Middle Name:BRYANNE
Last Name:MEEDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 GHARRETT AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-3203
Mailing Address - Country:US
Mailing Address - Phone:406-381-1076
Mailing Address - Fax:
Practice Address - Street 1:125 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-5117
Practice Address - Country:US
Practice Address - Phone:307-886-5266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program