Provider Demographics
NPI:1730850645
Name:MEREDITH, CHRISTINE ELAINE (NP-C)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ELAINE
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:GRIZZLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4441 LONG PRAIRIE RD
Mailing Address - Street 2:STE 400
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-5410
Mailing Address - Country:US
Mailing Address - Phone:443-417-5796
Mailing Address - Fax:
Practice Address - Street 1:3901 W 15TH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7738
Practice Address - Country:US
Practice Address - Phone:443-417-5796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1055015363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner