Basic Information
Provider Information | |||||||||
NPI: | 1659840288 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BATTY | ||||||||
FirstName: | MEREDITH | ||||||||
MiddleName: | JOHANNA | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CNM | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HOREL | ||||||||
OtherFirstName: | MEREDITH | ||||||||
OtherMiddleName: | JOHANNA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1900 WOODLAND DRIVE | ||||||||
Address2: |   | ||||||||
City: | COOS BAY | ||||||||
State: | OR | ||||||||
PostalCode: | 97420 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5416615713 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 185 N 4TH ST | ||||||||
Address2: |   | ||||||||
City: | SAINT HELENS | ||||||||
State: | OR | ||||||||
PostalCode: | 970511535 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5033664540 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/13/2018 | ||||||||
LastUpdateDate: | 08/19/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/19/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WA0400X | 201808320RN | OR | N |   | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) | 171M00000X |   |   | N |   | Other Service Providers | Case Manager/Care Coordinator |   | 367A00000X | 202006872NP-PP | OR | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |   |
No ID Information.