Basic Information
| Provider Information | |||||||||
| NPI: | 1326369620 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEADE | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | RN, ACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3525 OLENTANGY RIVER RD | ||||||||
| Address2: | SUITE 4330 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432143937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142556900 | ||||||||
| FaxNumber: | 6142556901 | ||||||||
| Practice Location | |||||||||
| Address1: | 3525 OLENTANGY RIVER RD | ||||||||
| Address2: | SUITE 4330 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432143937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142556900 | ||||||||
| FaxNumber: | 6142556901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2010 | ||||||||
| LastUpdateDate: | 07/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 278701 | OH | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 363LA2100X | COA.11580-NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 0056523 | 05 | OH | MEDICAID |