Provider Demographics
NPI:1366050957
Name:MEACHAM, NIYOKIA ANTWANETTE (FNP)
Entity type:Individual
Prefix:
First Name:NIYOKIA
Middle Name:ANTWANETTE
Last Name:MEACHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 FARMER TRL
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004-7728
Mailing Address - Country:US
Mailing Address - Phone:623-414-0183
Mailing Address - Fax:
Practice Address - Street 1:601 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37044-0001
Practice Address - Country:US
Practice Address - Phone:623-414-0183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNF06202655363L00000X
TNAPN27994363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner