Provider Demographics
NPI:1275852311
Name:PRATT, MEGAN RAYBORN (APN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RAYBORN
Last Name:PRATT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:RAYBORN
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:1155 MILL ST # MCM14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:1500 E 2ND ST STE 100
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1189
Practice Address - Country:US
Practice Address - Phone:775-982-5003
Practice Address - Fax:775-982-5103
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1275852311Medicaid
12142433OtherCAQH
12142433OtherCAQH