Provider Demographics
NPI:1174690135
Name:MEDLEY, MEGGAN ANNE (DC, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:MEGGAN
Middle Name:ANNE
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:DC, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 W CALZADA CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4501
Mailing Address - Country:US
Mailing Address - Phone:520-975-1359
Mailing Address - Fax:520-818-3775
Practice Address - Street 1:15615 N ORACLE RD STE 135
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-9121
Practice Address - Country:US
Practice Address - Phone:520-818-3774
Practice Address - Fax:520-818-3775
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7239111N00000X
AZ289210363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ72684Medicare ID - Type Unspecified