Provider Demographics
NPI:1730644824
Name:MCNEIL, MEGAN VALLANCE (NP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:VALLANCE
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:RACHELLE
Other - Last Name:VALLANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3153 DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-4061
Mailing Address - Country:US
Mailing Address - Phone:251-340-6600
Mailing Address - Fax:251-479-7164
Practice Address - Street 1:125 E MAXWELL ST
Practice Address - Street 2:STE 303
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508
Practice Address - Country:US
Practice Address - Phone:859-257-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-153253363L00000X
KY3015539363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALA05323AOtherMEDICARE
AL512-22153OtherBCBS OF AL