Provider Demographics
NPI:1508591033
Name:SIKES, MEGAN MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:SIKES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E US HIGHWAY 80 STE 190
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8615
Mailing Address - Country:US
Mailing Address - Phone:469-602-5277
Mailing Address - Fax:469-995-7898
Practice Address - Street 1:104 E US HIGHWAY 80 STE 190
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-8615
Practice Address - Country:US
Practice Address - Phone:469-602-5277
Practice Address - Fax:469-995-7898
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1087852363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1087852OtherADVANCED PRACTICE LICENSE
TX1087852Medicaid