Provider Demographics
NPI:1215231196
Name:CONOVER, MEGAN M (PAC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:CONOVER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:E
Other - Last Name:MILSTONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2321 E GALA ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7692
Mailing Address - Country:US
Mailing Address - Phone:208-888-5848
Mailing Address - Fax:208-888-0884
Practice Address - Street 1:2321 E GALA ST STE 3
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7692
Practice Address - Country:US
Practice Address - Phone:208-888-5848
Practice Address - Fax:208-888-0884
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-19752084B0040X, 208D00000X, 363A00000X
AZ4798363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPA-1975OtherSTATE OF IDAHO PA-C LIC