Provider Demographics
NPI:1619145240
Name:BLAKEMORE, MEGAN RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENEE
Last Name:BLAKEMORE
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 1:1010 W ROUTE F
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:MO
Mailing Address - Zip Code:65243-9571
Mailing Address - Country:US
Mailing Address - Phone:573-687-3119
Mailing Address - Fax:
Practice Address - Street 1:800 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5275
Practice Address - Country:US
Practice Address - Phone:573-814-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-17
Last Update Date:2008-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant