Provider Demographics
NPI:1568131480
Name:JOHNSON, MEGAN B (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8681
Mailing Address - Fax:740-356-1256
Practice Address - Street 1:835 W EMMITT AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-1190
Practice Address - Country:US
Practice Address - Phone:740-947-7662
Practice Address - Fax:740-941-0099
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50.007194RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant