Provider Demographics
NPI:1376880948
Name:CALLIS, MEGAN (EMT-P)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:CALLIS
Suffix:
Gender:F
Credentials:EMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 CROWE ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320-1744
Mailing Address - Country:US
Mailing Address - Phone:270-256-9705
Mailing Address - Fax:
Practice Address - Street 1:500 HIGHWAY 69 N
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-9785
Practice Address - Country:US
Practice Address - Phone:270-298-4415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1051592, 3776-P146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic