Provider Demographics
NPI:1235779349
Name:BACKS, MEAGAN NICOLE (PA)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:NICOLE
Last Name:BACKS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:NICOLE
Other - Last Name:HENLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3276 N NORTHHILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4005
Mailing Address - Country:US
Mailing Address - Phone:479-404-2110
Mailing Address - Fax:479-404-2111
Practice Address - Street 1:3276 N NORTHHILLS BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4005
Practice Address - Country:US
Practice Address - Phone:479-404-2110
Practice Address - Fax:479-404-2111
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPENDING208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)