Provider Demographics
NPI:1770995508
Name:MEYER, MICHELLE MARTINE (PMHNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARTINE
Last Name:MEYER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARTINE
Other - Last Name:CLARKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7243 SAWMILL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-5005
Mailing Address - Country:US
Mailing Address - Phone:614-389-3814
Mailing Address - Fax:614-389-3841
Practice Address - Street 1:7243 SAWMILL RD STE 105
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016
Practice Address - Country:US
Practice Address - Phone:614-389-3814
Practice Address - Fax:614-389-3841
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.15910363LP0808X
OHAPRN.15910363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH579200OtherMEDICARE GRP PTAN
OHH5979201OtherMEDICARE IND PTAN
OH1568975795OtherGROUP (PRACTICE) NPI
OH0104001Medicaid
OH1568975795OtherGROUP (PRACTICE) NPI