Provider Demographics
NPI:1407434210
Name:WATHEN, MEGAN COLLEEN (FNP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:COLLEEN
Last Name:WATHEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:COLLEEN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3313 ALLENS LN
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47720-1528
Mailing Address - Country:US
Mailing Address - Phone:765-212-0184
Mailing Address - Fax:
Practice Address - Street 1:2525 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3421
Practice Address - Country:US
Practice Address - Phone:765-289-5408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010917A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily