Provider Demographics
NPI:1225348972
Name:DESELMS, MEGAN E (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:E
Last Name:DESELMS
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:801 ANCHOR RODE DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-2751
Mailing Address - Country:US
Mailing Address - Phone:239-263-1717
Mailing Address - Fax:239-403-9410
Practice Address - Street 1:801 ANCHOR RODE DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-2751
Practice Address - Country:US
Practice Address - Phone:239-263-1717
Practice Address - Fax:239-403-9410
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2022-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9112107363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB38059Medicare Oscar/Certification
WAG8903691Medicare PIN