Provider Demographics
NPI:1558400135
Name:RODGERS BRICKWEG, MEGAN LEIGH (PA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEIGH
Last Name:RODGERS BRICKWEG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LEIGH
Other - Last Name:RODGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 801106
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1106
Mailing Address - Country:US
Mailing Address - Phone:800-953-0104
Mailing Address - Fax:303-765-6670
Practice Address - Street 1:2535 S DOWNING ST STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5848
Practice Address - Country:US
Practice Address - Phone:720-524-1367
Practice Address - Fax:720-524-1422
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18692363A00000X
COPA.0004396363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52430251Medicaid