Provider Demographics
NPI:1235453713
Name:STEPHENS, MEGAN MARY (REEGT CNIM)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:MARY
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:REEGT CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 FOXCROFT RD
Mailing Address - Street 2:703
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-2410
Mailing Address - Country:US
Mailing Address - Phone:501-413-9256
Mailing Address - Fax:
Practice Address - Street 1:2805 FOXCROFT RD
Practice Address - Street 2:703
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-2410
Practice Address - Country:US
Practice Address - Phone:501-413-9256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR246ZE0600X246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic