Provider Demographics
NPI:1730841487
Name:MEADOWS, LAKEN (PA-C)
Entity type:Individual
Prefix:
First Name:LAKEN
Middle Name:
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAKEN
Other - Middle Name:
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:363 COUNTY ROAD 3585
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:TX
Mailing Address - Zip Code:76073-5041
Mailing Address - Country:US
Mailing Address - Phone:540-931-2340
Mailing Address - Fax:
Practice Address - Street 1:1001 W EAGLE DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3745
Practice Address - Country:US
Practice Address - Phone:940-627-7440
Practice Address - Fax:940-703-6526
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1730841487Medicaid
TX8SV672OtherBCBS