Provider Demographics
NPI:1659717452
Name:HASELDEN, MEGAN ELVIS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ELVIS
Last Name:HASELDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:ELIZABETH
Other - Last Name:ELVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:580 MARY LOU AVE
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-6146
Mailing Address - Country:US
Mailing Address - Phone:843-241-3829
Mailing Address - Fax:
Practice Address - Street 1:4301 DICK POND RD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6807
Practice Address - Country:US
Practice Address - Phone:843-652-8100
Practice Address - Fax:843-652-8122
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMPA.1931 TL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant