Provider Demographics
NPI:1295406106
Name:HYATT, MEGAN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:HYATT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10840 BROADVIEW DR APT 305
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-8261
Mailing Address - Country:US
Mailing Address - Phone:919-830-8977
Mailing Address - Fax:
Practice Address - Street 1:2116 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-5310
Practice Address - Country:US
Practice Address - Phone:515-244-2267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001011607363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-11607OtherNORTH CAROLINA MEDICAL LICENSE
NONEOtherNONE