Provider Demographics
NPI:1275859001
Name:CLONCS, MEGAN N (NP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:N
Last Name:CLONCS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:N
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11911 N MERIDIAN STREET
Practice Address - Street 2:SUITE 110
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6919
Practice Address - Country:US
Practice Address - Phone:317-621-1151
Practice Address - Fax:317-621-1179
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28160778B363LA2200X
IN71003193A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200977340Medicaid
IN000000659680OtherANTHEM
INP01512483OtherRR MEDICARE
IN214440GMedicare PIN
INP01512483OtherRR MEDICARE