Basic Information
| Provider Information | |||||||||
| NPI: | 1396793774 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UNDERWOOD | ||||||||
| FirstName: | MEGHAN | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7756 | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278040756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2529851371 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1846 WILSON PIKE | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370677506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158292565 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 02/23/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 12069 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 3370186 | 01 | TN | MEDICAID GROUP # | OTHER | 4167860 | 01 | TN | BCBS PROV # | OTHER | 36432461 | 05 | TN | MEDICAID | 12069 | 01 | TN | APN LICENSE | OTHER | 3370186 | 01 | TN | MEDICARE GROUP # | OTHER |