Provider Demographics
NPI:1528400959
Name:COLVIN, MEGAN L (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:L
Last Name:COLVIN
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 1:7591 FERN AVE
Mailing Address - Street 2:SUITE 1705
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5750
Mailing Address - Country:US
Mailing Address - Phone:318-550-3398
Mailing Address - Fax:318-550-3481
Practice Address - Street 1:7591 FERN AVE
Practice Address - Street 2:SUITE 1705
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5750
Practice Address - Country:US
Practice Address - Phone:318-550-3398
Practice Address - Fax:318-550-3481
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAPA.200636363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical