Provider Demographics
NPI:1518631183
Name:SIM, MEGAN KATHLEEN (NP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:KATHLEEN
Last Name:SIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:SIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 749488
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9488
Mailing Address - Country:US
Mailing Address - Phone:239-432-8331
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:16403 OLD EMMITSBURG RD
Practice Address - Street 2:
Practice Address - City:EMMITSBURG
Practice Address - State:MD
Practice Address - Zip Code:21727-8929
Practice Address - Country:US
Practice Address - Phone:240-215-6310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR240701363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner